江西地区中老年胸腰椎骨折手术决策的调查△（开放获取）

(Open Access) A survey on surgical decision for thoracolumbar fracture in middle age and elderly in Jiangxi region

摘要:

[目的] 探讨江西地区骨科医师对50~65 岁中老年胸腰椎骨折患者的手术治疗决策现状。[方法] 对江西地区骨科医师进行问卷调查，问卷内容包括：调查对象的基本信息以及对50~65 岁中老年胸腰椎骨折患者的手术决策依据、内固定方式选择以及术后处理。[结果] 共回收319 份问卷，其中二级医院114 份、三级医院205 份。调查对象中初级职称79 人、中级117人、高级123 人。三级医院医师术前选择骨密度（bone mineral density, BMD） 检查的比例显著高于二级医院[例(%), 149 (72.7)vs 68 (59.6), P=0.017]。初级职称医师选择感染指标[例(%), 44 (55.7) vs 86 (73.5) vs 99 (80.5), P＜0.001]、肿瘤指标[例(%), 7 (8.9) vs46 (39.3) vs 71 (57.7), P＜0.001] 以及BMD 检查[例(%), 25 (31.6) vs 89 (76.1) vs 103 (83.7), P＜0.001] 的比例显著低于中、高级职称。三级医院骨科医师选择BMD 作为手术决策依据的比例显著高于二级医院[例(%), 157 (76.6) vs 72 (63.2), P=0.011]。初级职称选择经皮微创螺钉固定的比例显著低于中、高级职称（P＜0.001）。对于伤椎骨块突入椎管但无神经症状的患者，随着职称等级的升高，选择减压的比例显著降低（P＜0.001）。初级职称医师选择不进行椎体内植骨的比例显著高于中高级职称医师（P＜0.001）。三级医院选择内固定术后拔除引流管即开始下地活动的比例显著高于二级医院[例(%), 119 (58.0) vs 53 (46.5), P=0.012]，初级职称医师选择内固定术后卧床超过1 个月的比例显著高于中高级职称[例(%), 12 (15.2) vs 3 (2.6) vs 4 (3.3), P＜0.001]。[结论] 江西地区骨科医师对50~65 岁中老年胸腰椎骨折患者的手术治疗决策差异大，缺乏规范的手术治疗决策依据。

Abstract:

[Objective] To investigate the current situation of surgical treatment decision of orthopaedic surgeons for thoracolumbarfracture among 50~65 years old patients in Jiangxi region. [Methods] A questionnaire survey was conducted among orthopedic surgeons inJiangxi province. The questionnaire included the basic information of the survey subjects, the basis for surgical decision making, the selec-tion of internal fixation methods and the postoperative management of thoracolumbar fracture in patients aged from 50 to 65 years. [Results]A total of 319 questionnaires were collected, including 114 from secondary hospitals and 205 from tertiary hospitals. Among the survey sub-jects, 79 were junior professional titles, 117 were intermediate, and 123 were senior. The proportion of preoperative bone mineral density(BMD) examination by physicians in tertiary hospitals was significantly higher than that in secondary hospitals [cases (%), 149 (72.7) vs 68(59.6), P=0.017]. Junior physicians selected infection indexes [cases (%), 44 (55.7) vs 86 (73.5) vs 99 (80.5), P＜0.001], tumor indexes [cas-es (%), 7 (8.9) vs 46 (39.3) vs 71 (57.7), P＜0.001] and BMD examination [cases (%), 25 (31.6) vs 89 (76.1) vs 103 (83.7), P＜0.001] were sig-nificantly lower than those with middle and senior professional titles. The proportion of orthopedic surgeons in tertiary hospitals choosingBMD as the basis for surgical decision-making was significantly higher than that in secondary hospitals [cases (%), 157 (76.6) vs 72 (63.2),P=0.011]. The proportion of minimally invasive screw fixation in junior professional titles was significantly lower than those with the middleand senior professional titles (P＜0.001). For the patients with injured vertebrae protruding into the spinal canal but no neurological symp-toms, the proportion of decompression was significantly decreased with the increase of professional rank (P＜0.001). The junior professionaltitles who chose not to do intravertebral bone grafting was significantly higher than the middle and senior professional titles (P＜0.001). Theproportion of ambulation immediately after drainage tube removal after internal fixation in tertiary hospitals was significantly higher than that in secondary hospitals [cases (%), 119 (58.0) vs 53 (46.5), P=0.012]. The junior professional titles who chose to stay in bed for morethan 1 month after internal fixation was significantly higher than those with middle and senior professional titles [cases (%), 12 (15.2) vs 3(2.6) vs 4 (3.3), P＜0.001]. [Conclusion] There is a great difference in surgical decision making among orthopedic surgeons in Jiangxi regionfor thoracolumbar fracture in patients aged 50~65 years, and there is a lack of standard basis for surgical decision making.