Jerome J Terrence Jose, Mercier Francisco, Mudgal Chaitanya S, Arenas-Prat Joan, Vinagre Gustavo, Goorens Chul Ki, Rivera-Chavarría Ignacio J, Sechachalam Sreedharan, Mofikoya Bolaji, Thoma Achilleas, Medina Claudia, Rivera-Chavarría Ignacio J, Henry Mark, Afshar Ahmadreza, Dailiana Zoe H, Prasetyono Theddeus O H, Artiaco Stefano, Madhusudhan Thayur R, Ukaj Skender, Reigstad Ole, Hamada Yoshitaka, Bedi Rajesh, Poggetti Andrea, Al-Qattan Mohammad Manna, Siala Mahdi, Viswanathan Anand, Romero-Reveron Rafael, Hong Joon Pio, Khalid Kamarul Ariffin, Bhaskaran Shivashankar, Venkatadass Krishnamoorthy, Leechavengvongs Somsak, Goorens Chul Ki, Nazim Sifi, Georgescu Alexandru Valentin, Tremp Mathias, Nakarmi Kiran K, Ellabban Mohamed A, Chan Pingtak, Aristov Andrey, Patel Sandeep, Moreno-Serrano Constanza L, Rai Shwetabh, Kanna Rishi Mugesh, Malshikare Vijay A, Tanabe Katsuhisa, Thomas Simon, Gokkus Kemal, Baek Seung-Hoon, Brandt Jerker, Rith Yin, Olazabal Alfredo, Saaiq Muhammad, Patil Vijay, Jithendran N, Parekh Harshil, Minamikawa Yoshitaka, Atagawi Abdulljawad Almabrouk, Hadi Jalal Ahmed, Berezowsky Claudia Arroyo, Moya-Angeler Joaquin, Altamirano-Cruz Marco Antonio, Galvis R Luz Adriana, Antezana Alex, Paczesny Lukasz, Fernandes Carlos Henrique, Asadullah Md, Yuan-Shun Lo, Makelov Biser, Dodakundi Chaitanya, Regmi Rabindra, Pereira Ganarlo Urquizo, Zhang Shuwei, Sayoojianadhan Binoy, Callupe Ivan, Rakha Mohamed I, Papes Dino, Ganesan Ramesh Prabu, Mohan Mukesh, Jeyaraman Arun, Prabhakar Ponnaian, Rajniashokan Arungeethayan, Geethan I, Chandrasekar Sugavanam, Löw Steffen, Thangavelu Kannan, Giudici Luca Dei, Palanisamy Yuvarajan, Vaidyanathan Singaravadivelu, Boretto Jorge, Ramirez Monica Alexandra, Goundar Thirumalaisamy Subbiah, Kuppusamy Thirumavalavan, Kanniyan Kalaivanan, Srivastava Atul, Chiu Yung-Cheng, Bhat Anil K, Gopinath Nalli R, Vasudevan Vijayaraghavan P, Abraham Vineet
Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Tamil Nadu, India.
Cl ínica Lambert Rua, Cordeiro Ferreira, Lisbon, Portugal.
J Hand Microsurg. 2020 Dec;12(3):135-162. doi: 10.1055/s-0040-1713964. Epub 2020 Jul 6.
With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
在充满诸多不确定性、管理协议不明且频繁变化的情况下，新冠疫情在这场大流行危机期间对骨科手术实践产生了重大影响。世界各地的外科医生需要进行深入反思、思考，并就安全的手术操作和预防病毒污染达成前瞻性的共识性建议。来自50个国家的100名骨科医生收到了一份谷歌在线表格问卷，其中详细说明了入院、手术、出院、随访的协议，影响他们手术实践的相关信息、面临的困难以及封锁期间及之后发生的许多其他重要问题。10名外科医生对数据进行了批判性分析和解读，以形成合理的指导方针和建议。参与调查的人员中，手外科和显微外科医生占52%，创伤外科医生占32%，关节置换外科医生占20%，关节镜外科医生占14%。参与研究的有来自国家公共卫生保健/政府学院医院的外科医生（44%）和私立/半私立从业者（54%）。在撰写本文时，一些国家早在2020年1月3日就开始实施封锁，少数国家部分或完全解除了封锁。58%的外科医生在封锁期间没有停止手术或诊所工作，但只选择处理急诊病例。大多数外科医生（49%）的患者就诊总量减少了四分之三，其余病例采用保守方法处理（54%）。手术数量减少了50%至75%。外科医生在没有进行新冠病毒检测的情况下进行了急诊手术，但对于所有择期手术病例，他们更倾向于采用逆转录聚合酶链反应（RT-PCR；77%）和胸部计算机断层扫描（CT）（12%）检测。开放性骨折和急诊手术（60%）以及桡骨远端骨折（55%）是最常进行的手术。外科医生更倾向于使用配备呼吸器（N95/FFP3）的全套个人防护装备，但在无法获得的情况下，他们使用外科口罩和普通手术服。区域/局部麻醉（70%）仍然是他们手术的首选，以防止污染的气溶胶化风险。70%的外科医生鼓励进行有限人员和次数的必要手术随访，而30%的外科医生采用远程会诊和远程康复。尽管有防护设备，三分之一的外科医生担心被感染，56%的外科医生担心感染他们的亲人和朋友。私人执业的骨科医生确实面临50%至75%的经济损失，不得不让25%的员工和50%的医护辅助人员休假。骨科会议被取消，虚拟会议已成为分享知识和经验以避免人员接触的首选方式。待在家里、阅读和撰写手稿变得更有趣，外科医生的生活方式发生了有趣的变化。毫无疑问，所有人都一致接受了这样一个事实，即新冠疫情已达到前所未有的程度，个人卫生、洗手、社交距离和安全的手术操作是可行的应对措施，他们都已逐渐将这些做法融入到自己的生活中。严格遵守地方当局的建议和指导方针，统一和标准化入院、住院和出院规范，术前和部分病例进行胸部CT扫描时进行强制性RT-PCR检测，优化和规范手术，避免和推迟非急诊手术及随访协议，谨慎使用远程会诊，并与世界卫生组织和国家医疗系统密切合作，将为骨科医生及其同行提供一个有利和安全的工作环境，也将防止新冠疫情的再次爆发。
