高海拔地区义诊中肢体畸形的现状调查

A cross-section survey on limb deformity during free medical care service in the high-altitude area

摘要:

[目的] 探索高海拔地区肢体畸形的主要病因病种，为制定切实可行的防治策略提供数据支持。[方法] 2021 年 5 月—12 月，以 7 次巡回诊疗、1 次义诊和 1 次筛查为基础，采取个人访谈、问卷调查以及现场查体等方式，对四川省理塘县各类肢体残疾畸形被调查者的基本情况进行信息收集，初步分析畸形特点。[结果]本研究共调查 530 人，肢体畸形残疾者为 364 例，占 68.7%。其中，先天性畸形 29 人（8.5%），外伤后畸形 15 人（4.4%），退行性畸形 253 人（74.0%），神经后遗症畸形 45 人（13.1%），其他畸形 22 人（6.0%）。所有畸形者中，藏族 363 人，汉族 1 人。下肢畸形发生率高于上肢，膝关节畸形是最主要畸形部位，发生率为 49.8%（264/530）。膝关节畸形多为骨性关节炎，双侧受累，重度居多，多数尚未手术治疗。[结论]理塘县肢体残疾畸形发生率较高，主要为藏族，致畸原因为骨性关节炎、神经障碍后遗症以及先天性肢体畸形等，可能与高海拔地区高寒缺氧环境、藏区牧民劳作方式及当地医疗条件有限等有关，应当引起关注。

关键词:肢体残疾;肢体畸形;高海拔地区;膝;骨性关节炎

Abstract:

[Objective] To explore the main causes and characteristics of limb deformity in high altitude area to provide data support for the formulation of feasible prevention and treatment strategies. [Methods] From May to December 2021, based on 7 rounds of medical service tour, 1 free medical checking and 1 screening, involving personal interview, questionnaire survey and on-site physical examination, the data regarding various physical disabilities and limb deformities in Litang County, Sichuan Province, were collected and analyzed pri- marily to present the characteristics of the limb deformities. [Results] Among the 530 persons who were investigated in this study, 364 cas- es were found disabled extremity with limb deformity, accounting for 68.7%. Of them, 29 (8.5%) were of congenital deformity, 15 (4.4%) of post-traumatic deformity, 253 (74.0%) of degenerative deformity, 45 (13.1%) neurological sequelae deformity, and 22 (6.0%) other malfor- mations. Among all persons who had deformities, 363 were Tibetan and 1 was Han. The incidence of lower extremity deformity was higher than that of upper extremity, and knee was the most common deformity site, with an incidence of 49.8% (264/530). Knee deformities were mostly osteoarthritis, with bilateral involvement and severe severity, most of which had not been treated surgically. [Conclusion] The inci- dence of limb deformity is high in Litang County, mainly affected the Tibetan nationality. The causes of deformity are osteoarthritis, sequel- ae of neurological disorders and congenital limb deformity, etc., which may be related to the high altitude and hypoxia environment, the working methods of herdsmen in Tibetan areas and the limited local medical conditions, etc., which should be paid attention to.

Key words:limb disability; limb deformity; high altitude area; knee; osteoarthritis