Objective To investigate the orthopaedic inpatients’ disease and cost constitution of the Third People’s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic department of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases (ICD-10). Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn’t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitalization cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient’s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient’s own expense reduced generally. Conclusion a) The total number of inpatients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b) The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe. c) The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d) Among all payment modes of hospitalization cost, the constituent ratio of patient’s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.
【Abstract】 Objective To explore the clinical application and outcomes of preoperative second measurement of three-dimensional (3-D) CT reconstruction data for scoliosis orthopedic surgery. Methods Between August 2006 and March 2008, 11 patients with severe rigid scoliosis received surgery treatment, including 4 males and 7 females with an average age of 17.2 years (range, 15-19 years). Preoperative second measurement of 3-D CT reconstruction data was conducted to guide the surgery， including the angle and width of pedicle, the entry point, and the choice of screws whose lengths and diameters were suitable. A total of 197 pedicle screws were implanted. The operation time， blood loss， postoperative nerve function，and Cobb’s angles at sagittal and coronal view were all recorded， and the postoperative CT scan was performed to assess the accuracy of pedicle screw insertion according to Andrew classification. Results Pedicle screws were implanted within 1-11 minutes (mean, 5.8 minutes), and the blood loss was 450-2 300 mL (mean, 1 520 mL). The postoperative X-ray films showed the correction rates of Cobb’s angle were 68.5% in coronal view and 55.5% in sagittal view. The accuracy of pedicle screw insertion was rated as grade I in 77 screws (39.1%)，grade II in 116 screws (58.9%)， and grade III in 4 screws (2.0%) according to postoperative CT scan. All 11 cases were followed up 14 months to 2 years without any complications. Conclusion Preoperative second measurement of 3-D CT reconstruction data can make the surgery process easy and accurate in treatment of severe scoliosis.
【Abstract】 Objective To investigate the appl ication and significance of computer assisted orthopedicsurgery(CAOS) in orthopedic trauma surgery. Methods In orthopedic trauma surgery, the appl ication status of CAOS was?analysed and the related problems were summarized. Results At present, CAOS is seldom used to reduce fractures but frequently used to insert internal fixation devices and reconstruct the cruciate l igament in orthopedic trauma surgery. And the studies have shown its superiority. During CAOS appl ication, surgeons should pay attention to some problems such as the disadvantages, cl inical evaluation, the roles of the surgeons and correct micro-traumatic concept. Conclusion CAOS is very important and cannot be replaced in orthopedic trauma minimal invasion surgery and surgeons should pay attention to some important related problems to make it develop successfully in the study of CAOS.
To introduce the current situation of platelet-rich plasma (PRP) and its appl ication in orthopedics field. Methods The latest l iterature was reviewed, concerning the preparations of PRP, physiological mechanism and the latest appl ications in orthopedics field. Results PRP represent a new biotechnology for the stimulation and acceleration of tissue heal ing and bone regeneration. To succeed, some of the challenges need to be addressed including standardization and definition of the different PRP preparations, the complete characterization of the platelet released factors and proteins. Furthermore, well-designed studies and cl inical trials are needed to evaluate the potential therapeutic impact ofPRP. Conclusion PRP provides a novel appl ication for orthopedics field.
Evidencebased medicine (EBM) is different fromtraditional medicine in that the practice of EBM comes from evidence and experience of the doctors. The objective evidence plays a key role in clinical practice. During the clinical teaching process, the following steps should be taken: firstly, the students should find a problem in their clinical practice; then, theyshould search for the evidence with the help of their teachers, evaluate the evidence, apply the evidence to the clinical practice, and solve the problem; finally, they should evaluate the effectiveness. An introduction of the principles and methods of EBM to the clinical practice can greatly improve the students’ ability to analyze and solve a clinical problem.
Objective To investigate the safety, efficacy and morbidity of onestage urethroplasty by using bladder mucosa for treatment of hypospadias. Methods From August 1991 to August 2003, 38 cases of congenital hypospadias were given bladder mucosa flap procedure and one stage urethroplasty. Results Thirty-eight cases of hypospadias treated with one stageurethroplasty by using bladder mucosa were followed up 6 months-9 years afterthe procedure. The success rate of the operation was 95%. Three cases of urethral fistula after the procedure were surgically repaired again, 2 cases of urethral stricture recovered after distension. The complication markedly lessened, micturation became normal with the reconstructed meatussituated at the proper site on the glands. Conclusion one stage urethroplastyby using bladder mucosa for treatment of hypospadias is a simple, effective andsafe surgery.
OBJECTIVE To evaluate the efficacy of transposition of the gastracnemius muscle in the limb-salvage operation of the proximal tibial tumor. METHODS From 1995, transposition of the gastrocnemius muscle was applied to cover the devitalized bone, bone cement or autologous bone graft in 15 cases with tumors of the proximal tibia (transposition of medial heads of gastrocnemius muscle in 12 cases, and lateral heads of gastrocnemius muscle in 3 cases respectively). Among them, there were 7 osteosarcomas, 5 giant cell tumors, 1 malignant fibrous histocytoma, 1 chondrosarcoma and 1 osteoblastoma. The operations included segmental devitalization with 95% alcohol in 7 cases, knee reconstruction of the unilateral tibial plateau with iliac graft in 5 cases, segmental devitalization with microwave in 2 cases, local resection and bone graft in 1 cases. RESULTS Apart from 2 cases whose wounds needed suturing again due to the liquefaction of the subcutaneous fat around the incision, no wound complications were occured in other 13 patients. No significant loss in the function of the leg and ankle was observed after transposition of the gastrocnemius muscle. There was no local recurrence, but 3 patients died due to lung metastases. CONCLUSION Transposition of the gastrocnemius muscle after resection of promixal tibial tumors can improve the local blood supply, cover the deep structures and prevent from the failure of limb-salvage operation due to wound complications.
OBJECTIVE To investigate the feasibility of osteoid callus allograft as a kind of bone healing promoting materials. METHODS The osteoid callus was obtained at one week after bilateral femoral fracture of a SD rat, then was kept at -196 C for 2 weeks. The bone defect model which bone repair was in intra-membranous osteogenesis was made at bilateral tibial shaft in 5 rats, and filled with the osteoid callus in the left defect area, the right side was filled with allogenous cancellous as control group. The specimen were processed with undecalcified technique and the sections were staining with light blue and sofranin T. RESULTS After 2 weeks, there were cartilage and bone formation in the defect area of osteoid callus graft group(3/4), medullary cavity formation in bone tissue with cartilage arround it, fibrous tissues between new bone and host bone. While there were no cartilage or bone formation in the control group. CONCLUSION The allograft osteoid callus is not absorbed by immunological rejection, but changed into bone tissue through endochondral osteogenesis. It is inspiring to develop osteoid callus allograft as a kind of material for bone healing.
Objective To investigate the inpatient’s disease and cost constitution of the Third People’s Hospital of Chengdu in 2009, so as to provide baseline data for further research. Methods The case records of inpatients in the Third People’s Hospital of Chengdu in 2009 were collected, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis and hospitalization expense etc. were rearranged and analyzed using Excel software. Results a) The total number of inpatients was 1 220, and male was more than female. The disease spectrum included 12 categories. b) A total of 1 093 inpatients suffered from the top 3 systematic diseases as follows: trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. c) According to ICD-10, the top 9 diseases of trauma and toxicosis were injuries to the wrist and hand, injuries to the hip and thigh, injuries to the knee and lower leg, injuries to the shoulder and upper arm, injuries to the lower back, lumbar spine and pelvis, injuries to the elbow and forearm, injuries to the thorax, injuries to the neck and injuries to the ankle and foot; the top 4 diseases in musculoskeletal system and connective tissue disorders were dorsopathies, soft tissue disorders, arthrosis, and osteopathies and chondropathies; among the factors affecting health and resulting from contact with health care institutions, removal of fracture fixation device. d) According to ICD-10 (list of three-digit catalogue and four-digit sub-catalogue), the top 5 single diseases in trauma and toxicosis were muscle and tendon injuries of the wrist and hand, intertrochanteric frature, fracture of the femoral neck, fracture of the tibia and fibula, and fracture of the lumbar spine; the top 5 single diseases in musculoskeletal system and connective tissue disorders were lumbar disc herniation, spondylosis, arthrosis of the knee, osteoporosis with pathological fracture, and osteonecrosis. e) The average hospital stay were 23.55 days, and the average cost per capita were 13 073.73 yuan which were constituted by material cost, drug cost including western and Chinese medicines, treatment expenses including blood transfusion fee, operation expenses including anesthetic fee, examination expenses including radiation fee and laboratory fee, bed fee and others. The inpatient costs were mainly at patient’s own expense, nearly a half of those expenses were paid by social security, and public medical care only accounted for less than 3% of the total payment. Conclusion In 2009: a) The male inpatients were mainly the young and middle-aged, and the female were the elderly. The main 3 systematic diseases were trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. b) The top 3 single diseases were lumbar disc herniation, muscle and tendon injuries of the wrist and hand, and intertrochanteric fracture. Except lumbar disc herniation, the other 2 single diseases were mostly seen in male rather than in female. c) The average hospital stay was 23.55 days. The overall costs were mainly constituted by material and drug cost (59.25%), with rationality worthy of attention. d) Inpatient costs were mainly at patient’s own expense or paid by social security, and the proportion of public medical care was low in the payment.
Objective To investigate the mental status of medical staffs in the orthopedics department during the earthquake, providing evidence for psychological intervention. Methods Choosing 104 staffs in the orthopedics department as eligible subject with convenient sampling; the research tool was Symptom Checklist-90. The questionnaire was done by the participants with the same instruction from psychological professionals; analyze the results. Results The score in somatization, anxiety and phobic anxiety of staffs in the orthopedics department was significantly higher than the national norm. Conclusion There exists disorder in mental health of medical staffs in orthopedics department, it is necessary to implement mental intervention.