Venter Santa-Marie, Dey Roopam, Khanduja Vikas, von Bormann Richard Pb, Held Michael
Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, Cape Town 7925, South Africa.
Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, Cape Town 7925, South Africa - Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town 7925, South Africa.
SICOT J. 2021;7:21. doi: 10.1051/sicotj/2021017. Epub 2021 Mar 26.
Great variety and controversies surround the management strategies of acute multiligament knee injuries (aMKLIs) and no established guidelines exist for resource-limited practices. The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopedic surgeons from nations with different economic status.
This descriptive cross-sectional scenario-based survey compares different management strategies for aMLKIs of surgeons in developed economic nations (DEN) and emerging markets and developing nations (EMDN). The main areas of focus were operative versus non-operative management, timing and staging of surgery, graft choice and vascular assessment strategies. The members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) were approached to participate and information was collected regarding their demographics, experience, hospital setting and management strategies of aMLKIs. These were analyzed after categorizing participants into DEN and EMDN based on the gross domestic product (GDP) per capita.
One-hundred and thirty-eight orthopedic surgeons from 47 countries participated in this study, 67 from DEN and 71 (51.4%) from EMDN. DEN surgeons had more years of experience and were older (p < 0.05). Surgeons from EMDN mostly worked in public sector hospitals, were general orthopedic surgeons and treated patients from a low-income background. They preferred conservative management and delayed reconstruction with autograft (p < 0.05) if surgery was necessary. Surgeons from DEN favored early, single stage arthroscopic ligament reconstruction. Selective Computerized Tomography Angiography (CTA) was the most preferred choice of arterial examination for both groups. Significantly more EMDN surgeons preferred clinical examination (p < 0.05) and duplex doppler scanning (p < 0.05) compared to DEN surgeons. More surgeons from EMDN did not have access to a physiotherapist for their patients.
Treatment of aMLKIs vary significantly based on the economic status of the country. Surgeons from DEN prefer early, single stage arthroscopic ligament reconstruction, while conservative management is favored in EMDN. Ligament surgery in EMDN is often delayed and staged. EMDN respondents utilize duplex doppler scanning and clinical examination more readily in their vascular assessment of aMLKIs. These findings highlight very distinct approaches to MLKIs in low-resource settings which are often neglected when guidelines are generated.
急性膝关节多韧带损伤（aMKLIs）的治疗策略多种多样且存在争议，对于资源有限的医疗机构而言，尚无既定的指南。本研究旨在比较不同经济状况国家的骨科医生对急性膝关节脱位（AKDs）的治疗方法。
这项基于情景的描述性横断面调查比较了经济发达国家（DEN）以及新兴市场和发展中国家（EMDN）的外科医生对aMLKIs的不同治疗策略。主要关注的领域包括手术治疗与非手术治疗、手术时机与分期、移植物选择以及血管评估策略。研究邀请了国际骨科学与创伤外科学会（SICOT）的成员参与，并收集了他们的人口统计学信息、经验、医院环境以及aMLKIs的治疗策略。在根据人均国内生产总值（GDP）将参与者分为DEN和EMDN两组后，对这些信息进行了分析。
来自47个国家的138名骨科医生参与了本研究，其中67名来自DEN，71名（51.4%）来自EMDN。DEN组的医生经验更丰富且年龄更大（p < 0.05）。EMDN组的医生大多在公立医院工作，是普通骨科医生，治疗的患者多来自低收入背景。如果有必要进行手术，他们更倾向于保守治疗并延迟使用自体移植物进行重建（p < 0.05）。DEN组的医生则倾向于早期、一期关节镜下韧带重建。选择性计算机断层扫描血管造影（CTA）是两组最常用的动脉检查方法。与DEN组的医生相比，显著更多的EMDN组医生更倾向于临床检查（p < 0.05）和双功多普勒扫描（p < 0.05）。更多来自EMDN的医生无法为其患者配备物理治疗师。
aMLKIs的治疗因国家的经济状况而有显著差异。DEN组的医生倾向于早期、一期关节镜下韧带重建，而EMDN组则更倾向于保守治疗。EMDN组的韧带手术往往会延迟且分期进行。EMDN组的受访者在对aMLKIs进行血管评估时更倾向于使用双功多普勒扫描和临床检查。这些发现凸显了在资源匮乏地区对MLKIs采用的截然不同的治疗方法，而在制定指南时这些方法常常被忽视。
