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首页> 外文期刊>Injury >The treatment of segmental tibial fractures: does patient preference differ from surgeon choice?
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The treatment of segmental tibial fractures: does patient preference differ from surgeon choice?

机译：细分胫骨骨折的治疗方法：患者偏好是否与外科医生选择不同？

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摘要

Abstract Introduction Segmental tibial fractures are complex injuries with a prolonged recovery time. Current definitive treatment options include intramedullary fixation or a circular external fixator. However, there is uncertainty as to which surgical option is preferable and there are no sufficiently rigorous multi-centre trials that have answered this question. The objective of this study was to determine whether patient and surgeon opinion was permissive for a randomised controlled trial (RCT) comparing intramedullary nailing to the application of a circular external fixator. Materials and methods A convenience questionnaire survey of attending surgeons was conducted during the United Kingdom’s Orthopaedic Trauma Society annual meeting 2017 to determine the treatment modalities used for a segmental tibial fracture (n=63). Patient opinion was obtained from clinical patients who had been treated for a segmental tibial fracture as part of a patient and public involvement focus group with questions covering the domains of surgical preference, treatment expectations, outcome, the consent process and follow-up regime (n=5). Results Based on the surgeon survey, 39% routinely use circular frame fixation following segmental tibial fracture compared to 61% who use nail fixation. Nail fixation was reported as the treatment of choice for a closed injury in a healthy patient in 81% of surgeons, and by 86% for a patient with a closed fracture who was obese. Twenty-one percent reported that they would use a nail for an open segmental tibia fracture in diabetics who smoked, whilst 57% would opt for a nail for a closed injury with compartment syndrome, and only 27% would use a nail for an open segmental injury in a young fit sports person. The patient and public preference exercise identified that sleep, early functional outcomes and psychosocial measures of outcomes are important. Conclusion We concluded that a RCT comparing definitive fixation with an intramedullary nail and a circular external fixator is justified as there remains uncertainty on the optimal surgical management for segmental tibial fractures. Furthermore, psychosocial factors and early post-operative outcomes should be reported as core outcome measures as part of such a trial. ]]>
机译：摘要介绍节段胫骨骨折是复杂损伤，延长恢复时间。目前的最终治疗选项包括髓内固定或圆形外固定器。然而，有不确定的是哪种外科选择是优选的，并且没有足够严格的多中心试验，已经回答了这个问题。本研究的目的是确定患者和外科医生的意见是否允许随机对照试验（RCT）对比较髓内钉在循环外固定器的应用中进行比较。材料和方法在联合王国的骨科创伤社会年会2017年期间进行了对出席外科医生的便利问卷调查，以确定用于节段性胫骨骨折的治疗方式（n = 63）。患者意见是从被患者和公共参与焦点小组的部分胫骨骨折治疗的临床患者获得，其中包含涵盖外科偏好，治疗期望，结果，同意过程和后续行动的问题（n = 5）。基于外科医生调查的结果，39％常规使用圆形框架固定在节段性胫骨骨折后的圆形框架固定与使用钉固定的61％相比。据报道指甲固定作为治疗健康患者在81％的外科医生中闭合损伤的选择，并且患有肥胖的骨折的患者的86％。二十一度百分之二十一百分之称，他们将在吸烟的糖尿病患者中使用钉子进行开放的节段骨折，而57％会选择用隔间综合征闭合伤害的钉子，只有27％将使用钉子进行开放的节段在年轻契合体育人士受伤。患者和公共偏好运动确定睡眠，早期功能结果和后果的心理社会措施都很重要。结论我们得出结论，将定位定位与髓内钉和圆形外固定器的RCT相比是合理的，因为对节段性胫骨骨折的最佳手术管理仍然存在不确定性。此外，应将心理社会因素和早期的术后结果报告为核心结果措施，作为此类试验的一部分。 ]]>

著录项

  • 来源
    《Injury》 |2017年第10期|共5页
  • 作者

    Z. Little; T.O. Smith; S.E. McMahon; C. Cooper; A. Trompeter; M. Pearse; S. Britten; B. Rogers; H. Sharma; B. Narayan; M. Costa; D.J. Beard; C.B. Hing;

  • 作者单位

    ST5 Trauma and Orthopaedics St Helier Hospital;

    Faculty of Medicine and Health Sciences University of East Anglia;

    Royal Victoria Hospital;

    RCS Surgical Intervention Trials Unit NDORMS University of Oxford;

    Department of Trauma and Orthopaedics St George’s Hospital;

    St Mary’s Hospital;

    Leeds Teaching Hospitals NHS Trust;

    Brighton &

    Sussex University Hospitals NHS Trust;

    Hull and East Yorkshire NHS Hospitals Trust;

    Royal Liverpool and Broadgreen Hospitals;

    University of Oxford Oxford Trauma The Kadoorie Centre John Radcliffe Hospital;

    Surgical Intervention Trials Unit (SITU) Nuffield Dept. of Orthopaedics Rheumatology and;

    Department of Trauma and Orthopaedics St George’s Hospital;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 创伤外科学;
  • 关键词

    Tibia; Segmental; Fracture; Surgeon; Preference; Trial;

    机译：胫骨;节段;骨折;外科医生;偏好;审判;

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