According to the spirit of the Notice of the National Health Commission on Carrying out the Pilot Work of Accelerated Rehabilitation (GuoWei Medical Letter [2019] No. 833) and the Notice of the Medical Administration Bureau of the National Health Commission on Doing a Good Job in the Pilot Work of Accelerated Rehabilitation Surgery orthopedics (Guo Wei Medical Convenience Letter [2020] No. 35), the pilot work is being smoothly advanced in an orderly manner as required. In order to truly implement eras and its research results and consensus (guidelines) in China's orthopedic trauma and further innovate and improve, and better promote the construction of orthopedic pilot hospitals for accelerated rehabilitation surgery, benefiting more patients across the country, Beijing Jishuitan Hospital, together with Bethune Orthopaedic Accelerated Rehabilitation Alliance, The Expert Committee of Accelerated Rehabilitation Surgery of the National Health Commission and the Peking Union Medical College Press, relying on the Chinese Journal of Bone and Joint Surgery, The Bethune Public Welfare Foundation Trauma orthopedics Professional Committee and the Beijing Perioperative Medical Research Association carried out a series of activities nationwide to "Strive for Excellence - Create a Trauma orthopedic Eras Demonstration Ward".
On May 9, 2021, the "Jinge (Yi) Refinement - Creation of Trauma orthopedics Eras Demonstration Ward Series Activities - Shanghai Station and 2021 Beijing- Shanghai Trauma orthopedics Academic Salon" was held as scheduled in Shanghai Jinshan Medical Device Service Industrial Park. As the "highlight" of the series of activities in 2021, this Shanghai station activity, together with the Trauma orthopedics Group of the Trauma Specialist Branch of the Shanghai Medical Association and a number of well-known experts in Jiangsu, Zhejiang and Shanghai, and the eras expert team of Beijing Jishuitan Hospital exchanged views on the same stage to jointly summarize and interpret the latest progress in the field of trauma orthopedic eras in the past six years, and at the same time display and share the achievements and experience in the creation of the eras demonstration ward of trauma orthopedics in Shanghai and surrounding areas.
The chairman of this meeting is Professor Ji Fang, who on behalf of the Trauma Orthopedics Group of the Trauma Specialist Branch of the Shanghai Medical Association, welcomed all the lecturers, students and participants, and hoped that in the post-epidemic era, the conference can further promote the learning and development of accelerated rehabilitation surgery in Suzhou, Shanghai and Zhejiang.
Professor Li Ting, on behalf of Beijing Jishuitan Hospital and "Excellence" to create the orthopedic orthopedics demonstration ward project, introduced the activity and the whole project, hoping to promote the application and research and innovation of eras in the entire diagnosis and treatment process of orthopedic trauma through the creation of the orthopedic orthopedic trauma demonstration ward, and also thanked the experts in Shanghai and Jiangsu, Zhejiang and Shanghai represented by President Zeng Bingfang and Director Ji Fang for organizing and participating in this activity. It has played a positive role in further promoting the exchange and development of orthopedic trauma in Beijing and Shanghai.
President Zeng Bingfang of Shanghai Sixth People's Hospital delivered a speech. Dean Zeng briefly introduced the development process of eras in the orthopedic community in China, and emphasized the in-depth impact of the cognition of eras concept on the perioperative medical work of orthopedics. It is hoped that through this meeting, the exchange of trauma orthopedic doctors in Beijing, Shanghai and other places and the understanding of the concept of eras can be further strengthened, and the construction of eras orthopedics demonstration wards can be promoted.
The first session of the conference was presided over by Sun Yuehua, Pan Zhijun, Sun Yuqiang and Professor Li Ting, and the expert team of Beijing Jishuitan Hospital reported on the progress of eras related work and interpreted the consensus and guidelines in detail.
Professor Wang Geng, Director of the Department of Anesthesiology of Beijing Jishuitan Hospital, introduced the necessity of assessing and adjusting the patient's preoperative internal medicine situation. Taking the preoperative internal medicine assessment of elderly hip fractures as an example, it is emphasized that we should start from the emergency assessment, conduct a comprehensive assessment of the functions of important systems and organs such as the cardiovascular system, respiratory system, and nervous system, and make timely and necessary adjustments, so that "the disease can be treated, the medicine cannot be stopped, the necessary examination, and the effective communication" should be carried out.
Professor Yang Minghui interpreted the "Guidelines for the Diagnosis and Treatment of Intertrochanteric Fractures of the Femur in the Elderly". With the aging of the population, the number of hip fractures is increasing. For intertrochanteric fractures of the femur in the elderly, early diagnosis and management of the emergency department, including emergency nerve block analgesia, conventional traction therapy is not recommended, and early surgery within 48 hours after injury is recommended. For the use and discontinuation of anticoagulants, a comprehensive judgment should be made in conjunction with the risk of thrombosis in the cardiovascular system. Lumbar anesthesia is preferred as a method of anesthesia. The surgical method is mainly intramedullary needle fixation, and the reduction process emphasizes the avoidance of large gaps between the folds as much as possible, and the satisfactory cortical contact, especially the anterior cortical contact, should be achieved. It is also crucial to prevent perioperative fractures and the occurrence of surgery-related complications.
Professor Zhang Bosong interpreted the "Consensus on Open Fracture Diagnosis and Treatment under the Eras Concept". For open fractures, evaluation is the most important step and should be assessed according to the ATLS process, with multidisciplinary consultation if necessary. Gustiloi, class II injuries are generally used first and second generation cephalosporin antibiotics, and class III injuries are recommended to increase aminoglycoside antibiotics and apply them as early as possible. The timing of the initial operation is to wait no more than 24 hours. There is no need for routine bacterial culture before or after debridement. Debridement requires a doctor with sufficient experience to complete it, and all non-viable tissue should be removed and well rinsed with plenty of salt water. According to the patient's general condition, local injury, treatment time, and doctor's experience, it is recommended to treat in stages, and severe soft tissue injury is recommended for phased treatment.
Professor Liu Yabo interpreted the "Consensus on the Diagnosis and Treatment of Tibia Plateau Fractures under the Eras Concept". Emergency evaluation is essential for tibia plateau fractures, and the possibility of popliteal artery injury and compartment syndrome should be ruled out and treated promptly. For the typing of the tibia platform, the schatzker typing is still the most classic typing, but it has certain limitations, only discusses the internal and external injuries, and currently recommends three-dimensional typing, focusing on sagittal and horizontal changes caused by different injury mechanisms and damage to the surrounding soft tissues. Surgical reduction should follow the principle of first reducing dislocation, then reducing fractures, first restoring the line of force, and then reducing the joint surface fracture.
Professor Cao Qiyong interpreted the "Consensus on the Diagnosis and Treatment of Pelvic Fractures under the Eras Concept". Pelvic emergency is an important part of diagnosis and treatment, attention should be paid to identifying potential bleeding risks, and the remaining alkalin values in blood gas analysis are an important indicator of massive blood loss. Methods of controlling bleeding include temporary external fixation immobilization, arterial embolism, and pelvic tamponade. The goals of the final treatment include painlessness, satisfactory activity, and ability to work.
Professor Li Ting interpreted the "Consensus on the Diagnosis and Treatment of Intercondylar Fractures of the Humerus Under the Eras Concept". Closed intercondylar fractures should be operated on as early as possible after injury, preferably within 1 week after injury, and gustiloi, type II open humerus distal fracture phase I is beneficial to patients' functional rehabilitation by internal fixation surgery on a satisfactory debridement basis. Ulnar nerve preposition should be given in patients with preoperative ulnar symptoms or intraoperative finding of ulnar nerve injury or unavoidable contact with ulnar nerve and internal fixators. The appropriate reduction sequence and internal fixation should be selected according to different fracture types and degrees of crushing.
Chief Nurse Zhang Chunling introduced the nursing work in the construction of the eras ward of trauma orthopedics. Care throughout the treatment is the cornerstone of eras implementation. The nursing team is an indispensable part of the team as a facilitator, evaluator, educator, communicator, implementer feedback, and observer. The specific clinical work of the nursing team includes health education (health education management plan, standardized education content, concise notification to reduce stress response), optimization of analgesia plan (multi-mode analgesia, standardized pain assessment process), and perioperative diet management.
At the end of the first section, the participating experts had a heated discussion. Some experts attending the meeting believe that it is widely believed that patients who routinely take aspirin, the risk of spinal hematoma in lumbar anesthesia may increase significantly, and Director Wang Geng introduced that according to the relevant literature, long-term conventional preoperative use of aspirin will not significantly increase the risk of spinal hematoma in lumbar anesthesia, according to the clinical study of Beijing Jishuitan Hospital, it also supports the above literature conclusions. In addition, the current clinical use of lumbar puncture needle puncture is less likely to cause bleeding and postoperative headache. As for whether antibiotic therapy is required after gustiloi surgery, Professor Zhang Bosong believes that according to clinical studies, antibiotic therapy should be routinely performed after surgery. For the problems related to the perioperative management of deep vein thrombosis of the lower extremities in patients with tibial plateau fractures, Professor Liu Yabo stressed that effective preventive measures can reduce the occurrence of deep vein thrombosis and are necessary; due to the particularity of trauma orthopedic patients, preoperative screening is also necessary, and if the lower extremity vein ultrasound suggests a risk of thrombosis, the vascular surgeon further treats it.
The second session of the conference was presided over by Lu Hua, Guo Xiaoshan, Chen Wenjun and Professor Zhang Wei. Experts from Sichuan, Jiangsu and Shanghai reported on the development of orthopedic trauma in different regions.
Professor Wang Guanglin of West China Hospital of Sichuan University explained the rapid rehabilitation and practice of elderly hip fractures, and for elderly patients, full attention should be paid to the assessment of preoperative hemoglobin, perioperative restrictive infusion, fracture reduction technology, perioperative blood management, anticoagulation, analgesia, sleep, prevention of nausea and vomiting and other multi-link treatment, and proposed that rehabilitation should pay attention to cardiopulmonary function rehabilitation and upper limb muscle strength rehabilitation.
Professor Li Xiang of Jiangsu Provincial People's Hospital explained some problems in the rehabilitation of tibia plateau fractures and introduced the treatment points of each link of the tibia plateau fracture treatment process.
Professor Chen Yunfeng of Shanghai Sixth People's Hospital explained the treatment strategy of proximal humerus fracture in the elderly, proposed that intramedullary fixation is suitable for the treatment of elderly osteoporotic proximal humerus fracture, and introduced the reinforced philos steel plate technology.
Professor Dong Yuqi of Shanghai Renji Hospital combined clinical experience and literature to discuss the clinical problems related to the failure of internal fixation of femoral neck fractures, including common clinical problems such as fracture typing, imaging measurement, internal fixation instrument selection, and postoperative weight bearing time selection.
Professor Tong Dake of Shanghai Ninth People's Hospital introduced the specific application of eras concept in preoperative, intraoperative and postoperative links through a case of elderly hip fractures, and discussed the risk factors and effective prevention methods for elderly hip fracture patients who fell again after surgery.
Professor Cheng Qun of Huadong Hospital in Shanghai taught the importance of osteoporosis treatment after orthopedic surgery and the treatment principles and methods from the perspective of an internist. Among the common anti-osteoporosis drugs, areondronic acid, dinosemai, lissedronic acid, and zoledronic acid are broad-spectrum anti-fracture drugs that can reduce the risk of hip, non-vertebral, and vertebral fractures. Bisphosphonate and teripatoptide are both drugs with positive significance for fracture healing.
In the discussion session after the second session, the participating experts had a heated discussion on related topics such as perioperative analgesia methods for elderly hip fractures, the safety of bone cement to strengthen the fixation of proximal humerus fractures, and the importance of coordinating eras work at the hospital management level.
At the end of the conference, Professor Wu Xinbao, Vice President of Beijing Jishuitan Hospital, summarized the activity. Dean Wu believes that in the past, clinical work was centered on "disease", and through in-depth study and cognition of the eras concept, the work center should be transformed into a "patient", which is a higher requirement and challenge for clinicians. This requires close and active multi-disciplinary cooperation to benefit more patients through efforts.
Zeng Bingfang, president of Shanghai Sixth People's Hospital, concluded his speech, fully affirming the contribution of the eras team to promoting the development of the eras concept in the Chinese orthopedic trauma and orthopedic community, and hoped that the majority of trauma orthopedic colleagues would actively participate in and make continuous efforts to improve the patient experience. At the same time, Dean Zeng suggested that the specific clinical work of the eras trauma orthopedic demonstration ward should be carried out in the form of clinical pathways.
The academic conference was held simultaneously in the form of offline and online joint holdings. The meeting summarized the latest progress in the field of orthopedic orthopedic trauma and the creation of the orthopedic eras demonstration ward of trauma, and conducted extensive and in-depth discussions and exchanges on many issues under the eras concept, and achieved good results. The conference further promoted the in-depth development of the creation of the eras demonstration ward of trauma orthopedics from the theoretical and practical levels.
Content source 丨 Accelerated Rehabilitation Salon