Sherick D G, Buchman S R, Patel P P
Division of Plastic and Reconstructive Surgery at the University of Michigan Medical Center, and St. Joseph Mercy Hospital, Ann Arbor 48109, USA.
Plast Reconstr Surg. 1998 Jul;102(1):28-31. doi: 10.1097/00006534-199807000-00004.
At the University of Michigan, the pediatric facial fracture call schedule rotates through the plastic surgery, otolaryngology, and oral surgery services. This situation provides an opportunity to evaluate differences in the management of pediatric facial fractures between subspecialty groups. At this hospital, a retrospective review of all pediatric facial fracture cases within a 5-year period was undertaken. Sixty patients with 82 facial fractures were studied along subspecialty lines. Differences in patient groups, practice patterns, and treatment strategies based on subspecialty assignment were found. Overall treatment followed traditional lines, with plastic surgeons involved in all types of pediatric facial fractures, whereas otolaryngology and oral surgeons were more limited in their operative scope, despite equal call responsibilities. It is believed that the managed care arena is a competitive environment in which it will be important to know the strengths and weaknesses of the plastic surgery specialty, as well as those of competing specialties, as patient contracts are negotiated. The overlap of plastic surgery, otolaryngology, and oral surgery in the care of facial trauma could result in plastic surgeons being left off of managed care participant lists. This study highlights plastic surgeons as efficient deliverers of quality care for pediatric facial fractures. Although the treatment of these fractures has fallen into the duties shared by all three subspecialties, data such as those presented here should strengthen our ability to succeed in the evolving environment of managed care.
在密歇根大学，小儿面部骨折的值班安排在整形外科、耳鼻喉科和口腔外科服务部门之间轮流。这种情况为评估各亚专业组在小儿面部骨折治疗方面的差异提供了机会。在这家医院，对5年内所有小儿面部骨折病例进行了回顾性研究。按照亚专业分类对60例患者的82处面部骨折进行了研究。发现基于亚专业分配的患者群体、实践模式和治疗策略存在差异。总体治疗遵循传统方式，整形外科医生参与所有类型的小儿面部骨折治疗，而耳鼻喉科医生和口腔外科医生的手术范围则较为有限，尽管他们的值班职责相同。人们认为，在管理式医疗领域，这是一个竞争激烈的环境，在谈判患者合同时，了解整形外科专业以及竞争专业的优势和劣势非常重要。整形外科、耳鼻喉科和口腔外科在面部创伤护理方面的重叠可能导致整形外科医生被排除在管理式医疗参与者名单之外。这项研究凸显了整形外科医生是小儿面部骨折优质护理的高效提供者。尽管这些骨折的治疗已成为所有三个亚专业共同承担的职责，但此处呈现的数据应能增强我们在不断演变的管理式医疗环境中取得成功的能力。
