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Nghiên cứu một số đặc điểm dịch tễ học và thực trạng cấp cứu ban đầu ở bệnh nhân gãy xương cơ quan vận động điều trị tại bệnh viện quân y 103 tt tiếng anh

MINISTRY OF EDUCATION

MINISTRY OF DEFENCE

AND TRAINING
VIETNAM MILITARY MEDICAL UNIVERSITY

NGUYEN HUU CHIEN

RESEARCH ON EPIDEMIOLOGICAL CHARACTERISTICS
AND THE FIRST AID STATUS OF BONE FRACTURES OF
MOTOR ORGANS IN PATIENTS TREATED AT 103
MILITARY HOSPITAL
Speciality: Surgery
Code: 9720104

SUMMARY OF MEDICAL DOCTORAL THESIS

HANOI - 2019



This research was carried out in
Vietnam Military Medical University

Supervisors:
1. Nguyen Tien Binh, M.D., Ph.D., Prof.
2. Pham Dang Ninh, M.D., Ph.D., Assoc.Prof.

Reviewer 1: Nguyen Van Thach, M.D., Ph.D., Assoc.Prof.
Reviewer 2: Nghiem Đinh Phan, M.D., Ph.D., Assoc.Prof.
Reviewer 3: Nguyen Thai Son, M.D., Ph.D., Assoc.Prof.
This thesis was defended in doctoral examination council
of

...........at … o’clock on ….

This thesis is available at:
1. National Library
2. ...........................................
3. …………………………...


1
INTRODUCTION
1. Imperativeness
Bone fractures in motor organs include spinal fractures, pelvic fractures
and limb fractures. There are many causes of bone fractures in motor organs.
The structure, the rate, distribution characteristics and causes of fractures
also vary depending on countries and regions.
There are about 16,000 people die from injuries over the world every day
(Mack C. et al, 2004). In Vietnam, the traffic accident rate was 27/100,000
people, higher than the global rate of 19/100,000 people (Ta Van Tram,
2006). Bone fracture is a severe surgical emergency, but if the first aid is
timely and properly (prevention of shock, fixation of fractures, prevention of
deviation and secondary injury, early transportation...), it will create good
conditions for treatment at the back level to have results. First aid is very
important. On one hand, right first aid, solid fracture fixation reduce the rate
of systemic and local complications such as shock, closed fractures into open
fractures, vascular and nerves lesions. On the other hand, the early rescue
also creates conditions for the post-treatment process to be more
convenient ... The timely and effective first aid was extremely important to
reduce the severity and mortality of injuries (Nguyen Thuy Quynh, 2013).
Bone fractures are interested in researchs by domestic and foreign
authors. In the world, most countries have accident and injury prevention
centers. In Vietnam, the aspects of injury prevention, the first aid of bone
fractures in motor organs has been noticed for about 10 years.
In order to have basic and systematic information of the epidemiological
characteristics and the first aid status of bone fractures in motor organs, this
reseach: “Research on epidemiological characteristics and the first aid
status of bone fractures in motor organs in patients treated at 103 Military
hospital” was perfomed with the following objectives:
1. To identify some epidemiological characteristics of fractures of
motor organs in patients treated at 103 Military hospital in the period of
2010 - 2014.
2. To survey the first aid status of bone fractures of motor organs in
patients treated at 103 Military hospital during this time.


2
2. Scientific significance
The thesis has provided data about some epidemiological
characteristics of motor fractures: results of age, gender and occupational
characteristics of fractured people; characteristics of causes and time of
fracture occurrence; fracture structural characteristics and fracture
properties ...
Furthermore, the thesis has provided information on the first aid status
of bone fractures in motor organs: the results of the proportion of patients
who were given first aid, the time from the accident to the emergency, the
means of transport, the rate of fracture were provided in accordance with
the principle.
3. Practical significance
The results of some epidemiological characteristics and the first aid
status of bone fractures in motor organs are the basis for building
investment promotion plan equipment for first aid for pre-hospital routes,
organizing training courses, training to improve emergency accident
knowledge for grassroots health and strengthen the coordination of
contracts between hospitals and pre-hospital to improve the quality of
first aid.
4. Structure of the thesis
The thesis consists of 111 pages: 2 pages of problems; Chapter 1
(Documentary Overview) 40 pages; Chapter 2 (Subjects and research
methods) 12 pages; Chapter 3 (Research results) 27 pages; Chapter 4
(Discussion) 27 pages; Conclusion 2 pages and 1 page perspectives.
The thesis has 29 tables, 6 charts, 3 figures and 126 references (39
Vietnamese documents, 97 English documents).


3
Chapter 1. DOCUMENTARY OVERVIEW
1.1. Overview of fractures and fracture classification
Fractures are lesions that cause loss of bone continuity due to injury or
pathology. Bone fractures in motor organs include limb fractures, vertebral
fractures, pelvic fractures and some other fractures (clavicle, shoulder blade,
kneecap).
There are many ways to classify fractures that are being applied clinically
now. The classification of fractures by cause is divided into injuries and
diseases (osteitis, bone syphilis, primary bone malignancy, bone cancer
metastasis, fatigue, and obstetric complications...). Classification of software
vulnerability includes classification of open fractures of Gustilo and
Anderson, classification of software vulnerability of Oestern and Tscherne.
Classification of bone lesions by mechanism of trauma, fracture position,
morphology and properties, according to Quinquist and Hansen, AO
synthesis classification.
1.2. Epidemiological of bone fractures in motor organs
The bone fractures in motor organs has been studied by many authors in
the world such as China, Iran, India, Brazil, America... Johansen A. et al.
studied fractures in the emergency department of the Cardiff Royal Hospital
found that the fracture rate was 21.1 / 1000 people / year (male: 23.5 / 1,000
people / year; female : 18.8 / 1,000 people / year). The frequency of fractures
was similar to that of the US, Australia and Norway, but higher in the UK in
the 1960s (9 / 1,000 people / year) (Johansen A. et al, 1997). In Vietnam,
bone fractures in motor organs are the leading cause of death and disability.
The burden of disability in both sexes was 2.7 million YLD in 2008 (Hanoi
School of Public Health, 2011).
Studies showed that the fracture rate had very different points, the
difference was not only by age, gender, region, even by race, skin color.
Humerus fractures accounted for about 1-3% of the total fractures. The
forearm fractures accounted for about 1.2% of total fractures, the femoral
fractures accounted for about 0.9% of total fractures, spinal fractures
accounted for 3 - 4% of the total fractures ...
1.3. The status of first aid and diagnosis of factures in Vietnam
The emergency situation of transporting patients in different countries
in the world is very diverse in form, types of participating forces, levels
of training and service access time.


4
There are many methods of transporting patients to hospitals such as
simple vehicles (rudimentary vehicles, trailers...), motor vehicles
(motorcycles, cars, small buses ...) and modern, high-speed vehicles (plane).
Countries have been focused on training the first responders in the field of
emergency techniques and transport of trauma patients such as Ghana,
Keyna, South Africa, Sri Lanka, Brazil, Colombia, Ecuador, Mexico,
Panama, Peru...The rate of non-first aid fracture victims was 82.14%, of
which upper and lower limb fractures accounted for 32.61% and 43.48%.
The rate of fracture victims fixed by bandages or splints is 8.93% (Dong
Ngoc Duc et al., 2009). Among injury cases, most of them rated first aid as
good and effective: 9.2% said it was very effective, 74.5% said it was
effective. The rate of effective and very effective first aid is quite high in
Thai Nguyen (98%), Thai Binh (94%), and Dong Thap (93%) (Nguyen
Thuy Quynh et al, 2003). 115 current emergency system is primarily
responsible for the emergency treatment of common diseases. The quantity
of traffic accident victims who was transported, first-aid by the 115
Emergency System is low, only about 10-15% of the quantity of traffic
accident victims to medical facilities. Many cases of emergency illnesses
including traffic accidents victims must be transported by means of nonprofessional facilities that are easy to cause complications or death before
going to the hospital. Many victims were not transported to hospitals by
specialized emergency vehicles but by other means such as taxi, motorcycle
taxi or even by truck because of many reasons including the lack of
ambulance. The main means that people use to bring victims to health
facilities was motorcycles, the time to reach health facilities was less than 30
minutes (58.6%) and 30 to 60 minutes (30.4%) (Nguyen Thuy Quynh et al,
2003). Most of the victims were often picked up by around people to the
hospital by available means (mostly by motorbikes) after traffic accidents in
Vietnam. The rate of transfer by motorbike from the field to the hospital was
84.48% (Pham Thi My Ngoc, 2013). Transporting fracture victims from the
vehicle to the clinic was still 33.3% by hand. There was still a large
proportion of picggy back carrying. Transport means, and the transport level
was still limited (Dong Ngoc Duc, 2009). There were 6.9% of cases going to
hospitals over 60 minutes (3 minutes - 100 minutes) (Pham Thi My Ngoc,
2013).


5
Chapter 2. SUBJECTS AND METHODS
2.1. Subjects
4918 patients with bone fractures of motor organs who were treated at
103 Military Hospital during 5 years (2010-2014).
* Selection criteria:
- Patients with fractures of motor organs whose medical records have
fully and clearly information according to the form of research medical
records.
- Patients who were initially treated at 103 Military Hospital (underwent
first aid at the accident place or the medical facility or the regional clinic
after undergoing fractures), and never been treated at any other hospital.
- Patients were diagnosed with arm, forearm, metacarpal-phalange,
femoral, tibia, fibula, metatarsal-phalange, vertebral and pelvic fractures
combined or not with other lesions (X-ray film with fractures also required).
* Exclusion criteria:
- Patients was hospitalized for the second and third time treatment... since
having fractures.
- Did not have all the necessary information of the patients in the form of
research medical record.
- Patient suffered a fracture due to another condition.
- Patients with traumatic brain injury.
- Patients suffered a fracture but they died before going to the hospital.
2.2. Methods
2.2.1. Research design
Cross-sectional descriptive study with continued follow-up on all
fracture patients at the hospital.
2.2.2. Sample size and sampling method
2.2.2.1. Sample size
Used the sample size calculation
(1 formula
p ) for a descriptive study:

n Z 2 (1  / 2 )

p 2

- n: Minimum sample size needed for research.


6
- Z1-α / 2: Reliability factor. With a threshold of α = 0.05 (95%
confidence level), Z1-α / 2 = 1.96 (look up the table).
- p: The rate of estimating a type of motor fracture in the total number of
fractures. We chose this ratio as 3% (0.03) according to the Military Medical
University's orthopedic injury in 2006 and according to Nguyen Tien Binh in
2009.
- ε: Relatively acceptable errors. In this study we choose ε = 16% (0.16).
Replacing the above parameters into the formula, the theoretical sample
size was calculated at 4852. In fact, we studied 4918 fractured patients in the
103 Military Hospital for 5 years (2010- 2014).
2.2.2.2. Sampling method
Applying convenient and standardized sampling methods: Introduced all
patients with motor organs fractures to the 103 Military Hospital Clinic then
allocated to treat at the Department of Orthopedic Trauma, Neurosurgery,
Surgical field, Emergency Resuscitation of 103 Military Hospital until
discharge, satisfying the selection criteria, exclude the above and until the
minimum amount necessary for the study was met.
2.2.3. Information collection method
The Toolkit used to collect information for the study is a research medical
record. This form was based on the research contents and objectives, has
been commented by experts in the specialized field and tested and revised
before officially conducting research.
2.2.4. Research variables
The general information of patients (age, gender, address, ethnicity,
religion, occupation, education level, cause of accident, type of vehicle, time
of accident, status before/after first aid and hospitalization), fracture position,
fracture, number of fractures, fractures characteristic: open fracture, joint
fracture, vascular injury, nerve damage, trauma, first aid place, time from
accident to first aid, first aid at grassroots health, first aid in emergency
room, first aid provider, fixed principles and means (length, firmness), pain
reduction, bandage wound, washing wounds, antibiotics and time of use,
injection of SAT and injection site, time from accident to hospital admission,
X-ray examination, diagnosis of grassroots health, clinics of 103 Military
Hospital and treated department, CT scanner / MRI.
2.2.5. Data processing methods


7
The data of the research records that were entered into the computer
by Excel software, were analyzed according to the research objectives
and processed by SPSS 22.0 software.
Apply descriptive statistical algorithms, calculate frequency, rate,
average and standard deviation, χ2 and p ... analyze the relationship
between variables.
2.2.6. Ethical issues of research
- Research protocol approved by the Ethics Council in Biomedical
Research of the Military Medical University.
- The data and information obtained are only for educational and
scientific research purposes and not for any other purpose.
- Patients who were hospitalized due to fracture of the motor organs
were given first aid at the Hospital Clinic, prepared and sent to Clinical
departments for treatment and treated according to the procedure,
treatment regimen of the hospital.
- Research files are carefully stored, kept confidential and only for
research purposes.
Chapter 3. RESULTS
3.1. Some epidemiological characteristics of fractures of motor
organs
Table 3.1. Distribution of subjects by age and sex (n=4,918)
1 – 19

Male
n
%
414
12,2

Female
n
%
124
8,1

20 – 29

992

242

Ages

30 – 39
40 – 49
50 – 59
60 – 69
70 – 79
80 – 99
Total
 ± SD
(Min – Max)

29,2

667
19,6
552
16,3
461
13,6
186
5,5
76
2,2
47
1,4
3.395 69,0
36,5 ± 16,3
(1 - 97 )

15,9

244
16,0
232
15,2
254
16,7
207
13,6
108
7,1
112
7,4
1.523 31,0
46,7 ± 20,1
(2 – 99)

Total
N
%
538
10,9
1.234

25,1

911
18,5
784
15,9
715
14,5
393
8,0
184
3,7
159
3,2
4.918 100,0
39,7 ± 18,2
(1 – 99)

p-values
0,000a
0,000a
0,003a
0,331a
0,004a
0,000a
0,000a
0,000a
0,000e


8
a. Chi-squared test
e.Mann-Withney test
Comments: The average age of patients was 39.7 ± 18.2 years old
(from 1 to 99). The average age of female patients was 46.7 ± 20.1 years
old which is significantly higher than that of male patients (46.5 ± 20.1
years old) (p <0.01).
Patients from 20 to 29 accounted for the highest rate of 25.1% , and
the patients from 30 to 39 accounted for 18.5%. The elderly and retired
group accounted for 15,9%. The ages of 50 onwards, the rate of fractures
tended to decrease.
Table 3.2. Distribution of subjects by occupation (n = 4,918)
Male
Female
Total
Occupation
n
%
N
%
N
%
Farmer
787
23.2
572
37.6
1359
27.6
Worker
724
21.3
151
9.9
875
17.8
Official
556
16.4
280
18.4
836
17.0
Student
505
14.9
160
10.5
665
13.5
Soldier
181
5.3
10
0.7
191
3.9
Freelance
642
18.9
350
23.0
992
20.2
workers
Total
3395
69.0
1523
31.0
4918
100.0
Comments: The quantity of fracture patients varied in occupational
groups. Farmer patients accounted for the highest proportion (27.6%),
workers (17.8%), government officials and staff (17.0%), pupils and
students (13.5%) and soldiers accounted for the lowest rate of 3.9%.
Table 3.3. Distribution of subjects by type of accident (n= 4,918)
Type of accident
Occupational
accidents

Male

Female

n

%

n

%

n

%

403

11.9

66

4.3

469

9.5

Car
Traffic
accident

Motorb
ike
Others

Total

95(4.2%)
1,609

47.4

659

43.3

2,033(89.6%)
1,40(6.2%)

46.1


9
Accidents in other
activities
Total

1,383

40.7

798

52.4

2,181

44.4

3,395

100

1,523

100

4,918

100

The rate of patients with traffic accidents was the highest (46.1%),
accidents in other activities (44.4%) and occupational accidents (9.5%).
In traffic accidents groups, motorbike accidents accounted for the highest
proportion (89.6%), others (6.2%), cars (4.2%).
The rate of men with occupational accidents and traffic accidents
were 11.9% and 47.4% respectively, which were higher than that of
women (occupational accidents 4.3% and traffic accidents 43.3%)(p
<0.01). With other types of accidents, female patients accounted for
52.4% higher than that of men (40.7%)(p <0.01).
The quantity of fractures tended to increase during the study period
from 2010 to 2014.
Traffic accidential fractures were occured usually at the beginning and
end of the lunar year (February, March, September and December).
Traffic accidents were occured usually in the evening, about 14-18 hours
(30.9%). Occupational accidents fractures were occured usually in the
morning (5 - 11 hours).
Among fracture cases, the rate of closed fracture was 74.9%, it was
higher than that of opened fracture (25.1%).
The lower limb fractures accounted for the highest rate of 54.2%; The
upper limb fractures accounted for the lower rate of 26.5%, the incidence
of limb fractures was 2.8% of the total. Other types of fractures
accounted for a low rate (spinal fractures 11.1%, pelvis fractures 3.0%).
Table 3.4. Distribution of patients by number of fractured bones
(n=4,918)
Number of fractured
Number of
Propotion
bones
patients
(%)
1 bone
4,447
90.42
2 bones
395
8.03
3 bones
69
1.4
4 bones
5
0.1
5 bones
2
0.04


10
Number of fractured
Number of
Propotion
bones
patients
(%)
Total
4,918
100
The number of patients with one fractured bone was highest
(90.42%), the number of patients with 2 fractured bones was 8.03%, the
patients with 3 or more fractured bones accounted for 1.55%.
The combined lesions of common limb fractures were articular, major
vascular and nerve injuries. The rate of upper limb injuries ranged from
29.7% to 34.3%, of lower limb injuries ranged from 26.1% to 32.7%.
The rate of upper limb fractures with shock was 5.1%; the rate of
lower limb fractures with shock was 6.2%; The rate of fracture with
shock was 24.6%.
Table 3.5. Distribution of patients by site and type of fracture
Opened
Closed
Total
fracture
fracture
p(n=4,918)
(n=1,233)
(n=3,685)
values
n
%
n
%
n
%
10.
Humerus
86
7.0
375
461
9.4
0.001
2
13.
10.
Radius, ulna
168
392
560
11.4
0.004
6
6
Metacarpals,
20.
255
92
2.5
347
7.1
0.0001
phalanges
7
13.
28.
Femur
162
1064
1226 24.9
0.0001
1
9
40.
22.
Tibia, fibula
505
816
1321 26.9
0.0001
9
1
Metatarsals,
10.
123
99
2.7
222
4.5
0.0001
phalanges
0
0.0
Pelvis
0
146
4.0
146
3.0
0.0001
0


11
14.
544
11.1
0.0001
8
14.
Others
94
7.6
525
619
12.6
0.0001
3
The above chart shows that the highest rate was fracture of the two
tibias in which the rate of opened two-tibiafracture (40.9%) was
significantly higher than that of closed two-tibiafracture (22.1%).
Closed fracture of femur ranked second (28.9%), opened femur
fracture accounted for 13.1%. Fracture of the hand and finger bone
accounted for 20.7%, ranked the third among the most common types of
bone fracture. Opened forearm bone fracture accounted for 13.6%.
Opened fracture of the foot and toe bone accounted for 10%.
3.2. The first aid status of bone fractures in motor organs in patients
Table 3.5.Distribution of patients under went first aid by accident place
and by first aid place (n = 4,918)
Medical
Accident
Emergency
facilities
places
rooms
Accident
(n=480)
(n=3,179)
(n=1,259)
place
n
%
n
%
n
%
Urban
179
37.3
433
34.4
1,186
37.3
Rural
286
59.6
726
57.7
1,906
60.0
High land
15
3.1
100
7.9
87
2.7
Total
480
9.8
1,259
25.6
3,179
64.6
The above chart shows that the rate of patients in urban who
underwent emergency on site and be transferred to emergency rooms was
37.3% , the rest rate of patients who underwent emergency in the
medical facilities was 34.4%. Patients in rural who underwent first aid in
emergency rooms accounted for 60%, which was highest percentage.
Patients in rural who underwent first aid at accident places accounted for
59.6%, and patients in rural who underwent first aid at medical facilities
accounted for 57.7%, which was lowest percentage. Patients in high land
who underwent first aid at medical facilities accounted for 7.9%, which
was highest percentage. Patients in high land who underwent first aid at
Vertebrae

0

0.0
0

544


12
accident places accounted for 3.1%, and patients in medical facilities
who underwent first aid in emergency rooms accounted for 2.7%, which
was lowest percentage. The difference between regions in terms of first
aid was statistically significant with p <0.05.
Table 3.6. Distribution of patients by time from accident to emergency
(n = 4,918)
Time (minutes)
n
%
<5
1,048
21.3
>5 – 15
2,399
48.8
>15 – 30
182
3.7
>30
1,289
26.2
Total
4,918
100.0
The above table shows that: Only 21.3% of patients with bone
fractures of motor organs was given first aid immediately within the first
5 minutes since the accident. 48.8% of them was given first aid within 515 minutes; 3.7% of them was given first aid within 15 - 30 minutes,
26.2% of them was given first aid after 30 minutes.
Table 3.7. Distribution of type of patient transportations from the
accident place to the following route (n = 4,918)
Types of transportation
n
%
Car
1,937
39.4
Motorbike
2,695
54.8
115 ambulance
79
1.6
Taxi
138
2.8
Others
69
1.4
Total
4,918
100
The above table shows that: the patients transportation from the
accident place to the following route were mostly motorcycles (54.8%),
automobiles (39.4%). 115 ambulance accounted for a very low rate
(1.6%).
Table 3.8. Distribution of first responders at the accident place (n =
480)
First responders
n
%
Non - medical staff
390
81.3


13
Medical staff
90
18.7
Total
480
100
The above table shows that: the rate of non - medical first responders
is high (81.3%). The rate of medical first responders is low (18.7%).
Table 3.9. Distribution of type of first aid methods by route
Acciden
Medical Emergenc
pt place
facilities
y room
Total
First aid
value
(n=480) (n=1.259) (n=3.179)
methods
s
n
%
n
%
n
%
n
%
16 34. 1,19 94. 2,83 89. 4,18 85.
Pain relief
0.001
5
4
1
6
0
0
6
1
Bandages(
55.
48.
59.
55.
79
167
476
722
0.001
*)
2
5
0
9
33 70. 1,19 94. 2,78 87. 4,32 87.
Fixation
0.001
8
4
5
9
7
7
0
8
Antibiotic
20.
18.
17.
s and SAT
0 0.0
59
152
221
0.001
7
8
9
(*)
Note: (*) opened fracture patients (n=1,233).
Patients who were given pain relief methods accounted for 34.4% at
accident place, 94.6% at medical facilities and 89,0% in emergency
room. The difference was statistically significant with p <0.01.
Patients who were given bandage accounted for 55.2% at accident
place, 48.5% at medical facilities, 59.0% in emergency room. The
difference was statistically significant with p <0.01.
The rate of patients who were given fixation accounted for 70.4% at
accident place, 87.7% at medical facilities, 87.8% in emergency room.
The difference was statistically significant with p <0.01.
The rate of patients who were given antibiotics and SAT accounted
for 0% at accident place, 20.7% at medical facilities, 18.8% in
emergency room. The difference was statistically significant with p<0.01.
The rates of patients with closed fractures who were given first aid
adherence to the principle were 11.8% at the accident place, 88.5% at
medical facilities and 68.3% in emergency room.


14
The rates of patients with opened fractures who were given first aid
adherence to the principle were 19.5% at medical facilities and 16.7% in
emergency room.
The rates of patients who were given fixation by medical splint, hand
made splint, splint that was enough length, splint that was stabilized
accounted for 48.4%, 51.6%, 92.1% and 96.5%, respectively.
85.1% of patients received painkillers, of which 19.3% used oral
medicines, 80.7% used injections. 56.1% of painkillers were used before
giving fixation and 43.9% of them were used after giving
immobilization.
18.6% of patients were given antibiotic prophylaxis , of which 8.8% used
oral medicines and 91.2% used injections.
The percentage of opened and closed fracture patients with wound
software given SAT were 44.0% at medical facilities, 60.9% in emergency
rooms. There was not any cases given SAT at accident places.
The percentages of opened fracture patients given bandages and wound
washing were 55.2% at accident places, 48.5% at medical facilities and
59.0% in emergency rooms.


15
Chapter 4. DISCUSSION
4.1. Some epidemiological characteristics of fractures of motor
organs
- Age: Our research results were consistent with Bui Thi Tu Quyen's
research. In the author's study, the average age of 93 motorbike injury
victims was 36.2. Traffic injury victims were mainly in the age group 2140 (55%), and the age group under 20 accounts for 16%. The study of
Dong Ngoc Duc and colleagues showed an association between age and
risk of traffic accidents. The risk of traffic accidents of the group of under
20 years old was 5.47 times higher than that of the group of over 60 years
old, 5.73 times higher than that of the 20-39 year old group and 4.61
times higher than that of the 40-59 age group. Le Quang Anh's study
found that the age group 25-40 accounted for 57.8%; the 41-60 age group
accounted for 20%.
- Gender: Our research results were similar to previous study authors:
Table 4.1. Distribution of sex.
Authors
Nguyen Thi Nhu Tu et al (2012)
Le Quang Anh (2012)
Nguyen Thi Chinh et al (2013)
Hoang Duc Thai (2016)
Nguyen Thi Xuan Trang (2011)
Nguyen Duc Chinh et al (2011)

Sample
size
471
717
289
99
262
62,229

Sex (%)
Male
Female
73.0
27.0
69.31
30.7
66.1
33.9
61.6
38.4
53.4
46.6
72.9
27.1

Bui Thi Tu Quyen (2004)

93

77,0

23,0

Luong Mai Anh (2012)
Dang Tuan An et al (2014)
Nguyen Huu Chien, 2019

2,036
385
4,918

63.1
74.6
69.0

36.9
25.4
31.0

We believed that men who participate in traffic had drunk alcohol,
drived at high speed, unable to control themselves so there rate was
higher.
- Occupation: our research results were consistent with some studies.
Nguyen Huy Thanh (2009): farmers accounted for the highest proportion
(44.3%), workers accounted for the lowest proportion (8.2%),


16
intellectuals accounted for 24.6% and other occupations accounted for
23%. Nguyen Thi Nhu Tu (2012): farmers were 41%, students were
32.5%, officials and employees 15.3% and children were 3%. Dang Tuan
An (2014): farmers and freelance workers were the majority (43% and
29%).
Table 4.2. Distribution of fracture causes.
Causes (%)
Authors
Ta Van
Tram (2006)
Le Quang
Anh (2012)

Hospitals
Tien
Giang
Hospital
Long
Thanh,
Nhon
Trach
Duc
Giang
Hospital

Traffic
accident

Occupational
accident

Accidents
in other
activities

7.55
1

75,3

24,5

0,3

717

51,1

29,6

1,0

n

Nguyen Thi
289
48,1
9,3
32,9
Chinh
(2013)
Nguyen Thi
Dak Lak
262
49,6
36,3
Xuan Trang
Hospital
(2011)
Nguyen
103
4918
46,1
9,5
44,4
Huu
Military
Chien,2019 Hospital
- Fracture causes: Accident injury was an important health problem,
accounted for 16% of the burden of disease worldwide. Injury was the
leading cause of death and disability in developing countries. In recent
years in our country, along with the rapid economic and social growth in
the country and the rapid urbanization rate in the regions was an increase
in types of injuries. Currently, injury accidents increased in all areas of
social life, especially injuries. According to the study, the highest number
of fracture patients due to injuries accounted for the highest rate (46.1%)
and the number of fracture patients due to occupational accidents was the


17
lowest (9.5%). Our research results were similar to some studies of
domestic authors.
- Fractures location: The fracture rate in our study was also consistent
with some other studies. Nguyen The Do (2012) treated 128 patients with
closed humerus fractures which were combined with screws. The author
found that there were 127 lesions combined in 128 patients (99.2%).
Patients with multiple injuries including abdominal and chest injuries and
humerus fractures accounted for 20.3%. The software wound was the
most common (32.8%). Chest injury, rib fracture, pleural effusion and
pneumothorax accounted for 14.8%. Radius and ulna fractures on the
same side accounted for 10.9%. Fibula and tibia fracture accounted for
6.3%. The rate of radial nerve paralysis before surgery was 21.7%. The
most common radial nerve paralysis position was in the middle third
accounting for 11.6%, 1/3 (10.1%). Vascular injuries accounted for 2.3%.
Phan Quang Tri (2015) studied 102 cases with distal humerus fractures
showed that injuries in the left side accounted for 60.8% and injuries in
the right side accounted for 39.2%.
According to Gartland classification, most of them were type III
deviation (27.5% of type IIIA; 24.5% of type IIIB), followed by type II
(40.2%) and 7.8% of type IIIC. There were 14 cases of vascular and
nerve damage (13.72%). In which 6 cases of nerve damage (5.88%): 2
rarial nerve damage cases, 3 middle nerve damage cases and 01 middle
and ulnar nerve damage case. Vascular lesions are 8 cases (7.84%), of
which there was 01 case of progressive humerus artery lesions into
Volkmann.
In 14 neural and vascular lesion cases, there were only 2 fracture
cases on type II, and 12 cases on type III (85.71% of type III was
Gartland fractures with complications). The study of Ha Dang Dinh in
2013 on 78 patients with fractures of the elbows found that the mainly
mechanism was direct (92.3%). The indirect mechanism was less
frequent (7.7%). Closed fractures accounted for 73.1%. Horizontal
fracture accounted for 42.3%, twisted fracture accounted for 12.8% and
fractures with fragments accounted for 38.5%. Schatzker classification:
type A accounted for 42.3%; type B accounted for 20.5%; type C
accounted for 3.8%; type D accounted for 17.9%; type E accounted for


18
9% and type F accounted for 6.4%. The incidence of combined lesions
was 19.3%: 5 patients with olecranon fractures had joint paralysis
(6.4%); 8 patients with olecranon fractures had accompanied by ulnar
body fractures, 01 patient with traumatic brain injury.
Tran Trung Dung (2013) studied 30 patients with 34 metacarpal and
phalange fractures found that the major lesions were metacarpal fractures
(52.9%), phalange fractures accounted for 47.1%. Crossed fracture
accounted for 52.9%; horizontal fracture accounted for 47.1%.
Nguyen Huu Thang (2009) treated intertrochanteric and subtrochanteric
fractures with AO braces for 41 patients (30 male and 11 female patients)
found 17.1% (7 patients) with intertrochanteric fractures type A1.1, A2.1 and
29.3% (12 patients) with intertrochanteric fractures type A2.2, A2.3, 26.9%
(11 patients) with subtrochanteric fractures type A3 and 21.9% (9 patients)
subtrochanteric fractures, 4.8% (2 patients) were not instant because of the
failure after combining bone. Morphological fractures: 78.1% of patients
were unstable intertrochanteric fractures, 17.1% of patients were solidly
intertrochanteric fractures; 4.8% of patients were not instant because of the
failure after combining bone.
Le Quang Tri (2014) treated the elderly intertrochanteric fractures with
external fixation found that the number of fracture patients on the left
(60.6%) was more than the right (39.4%). Classifying fracture according
to Jensen found that most of the patients in both study groups classified
group II and III fractures, each group accounted for 45%; group Ib only
accounted for 10%.
The results of our study on fibula and tibia fractures were similar to those
of Ho Van Binh (2005). The author studied 102 patients with opened fibula
and tibia fractures treated with the Fessa external fixation. He found that
fracture of the 1/3 middle was most common (46.1%), fractures on the left
side was 3 times more than on the right side. 6.9% of fractured patients with
2-stage fractures are severe fractures and complex for treatment. Broken
fragments with high frequency (62.3%) showed great injury power and the
software also hurted a lot. Opened fracture grade IIIB was the most
common (37.3%). The rate of fracture grade III was high (63.7%). Grade
II accounted for a high proportion (36.3%). The rate of vascular injury
was 11.5%.


19
4.2. The first aid status of bone fractures in motor organs in patients
- First aid place: First aid was extremely important in the program of
injury prevention. Studies have shown that if emergency cases are treated
promptly and effectively, it can reduce the severity and death of injuries.
The research results showed that the number of first aid patients in rural
areas accounted for the highest proportion with 59.6%, followed by
urban areas with 37.3% and in mountainous areas only 3.1%. The
difference between regions in terms of first aid was statistically
significant with p <0.05. Patients who given first aid at medical facilities
in rural areas accounted for the highest proportion with 57.7%, followed
by urban areas with 34.4% and in mountainous areas only 7.9%. The
difference between regions in the proportion of first aid at medical
facilities was statistically significant with p <0.05. The proportion of
patients who received first aid at the emergency room accounted for 60%
in rural areas, 37.3% in the urban area and 2.7% in of mountainous area.
The difference between regions in the rate of first aid at emergency room
was statistically significant with p <0.05.
This result was similar to Dong Ngoc Duc result on the situation of first
aid of motorbike drivers underwent traffic accidents: the rate of victims who
was given first aid at the accident place was very low (16.4%), the rate of
victims who was not given first aid was very high (83.6%).
Luong Mai Anh (2012) studied 2,036 cases of injuries caused by
occupational accidents and found that the rate of patients who was given first
aid was 60.8%. The rate of cases that was not given first aid was 35.2%.
The rate of self-treatment cases was 4%. The rate of cases which was given
first aid by medical staff was 59.4%, mainly in provincial hospitals 45.1%,
in district health care 32.8%. Victims who was given first aid by 115
emergency center accounted for only 1.4% of the cases received by
emergency medical workers. Victims who was given first aid by medical
staff of production facilities accounted for 4.5%.
- Emergency method:
We found that the proportion of patients who were given pain
reduction methods was 34.4% at accident place, 94.6% at the medical
facilities and 89.0% at the emergency room. The difference is statistically
significant with p <0.01. The rate of bandaged opened fractured patients


20
was 55.2% at the accident place, 48.5% at the medical facilities, 59.0%
with bandages in the emergency room. The difference is statistically
significant with p <0.01. The rate of patients who was given temporary
fixation was 70.4% at the accident place, 94.9% at the medical facilities,
87.7% in the emergency room. The difference is statistically significant
with p <0.01. The rate of opened patients who was given antibiotics and
SAT was 0% at the accident place, 20.7% at the medical facilities, 18,8%
in the emergency room.
Le Luong et al. (2012) surveyed the status of first aid of 2113 children
treated in Hai Phong Children's Hospital. He found that 80.08% of
children who was not given first aid before going to hospital, there was a
low rate of children who was given bandages (5.02%), immobilization
(6.67%), hemostatic methods (1.56%), infusion (0.47%), oxygen
breathing (0.05%). Patients who was given drugs at the hospitals was
3.36%.
Nguyen Thi Chinh et al. (2013) found that before being admitted to
hospital, the victim was rescued by health workers and first-aiders. In
which, the number of patients who was given bandages/hemostasis were
226 (78.2%); the number of patients who was given bandages and
hemostatic methods was 114 (39.4%); 1% patients was given infusion.
The most common first aid operations are bandaging and hemostatic
methods.


21
- First aid principle:
Research results showed that the rate of opened fracture patients who
was given correct first aid (both pain relief, bandage, fixation, antibiotic
and SAT) was 0% at the accident place, 19.5% at the medical facilities
and 13.8% in the emergency room. The difference is statistically
significant with p <0.05. The rate of opened fracture patients who was
given correct first aid (both pain relief, bandage, fixation, antibiotic and
SAT) was 11.8% at the accident place, 88,5% at the medical facilities and
68,3% in the emergency room. The difference is statistically significant
with p <0.05.
This was similar to the research results of Luong Mai Anh (2012): the
airway management quality was good (28.7%) and not good (3.2%). The
rate of non-airway management was 7.9%. The circulating management
quality was good (27.5%) and not good (4.0%). The rate of non-circulation
management was 8.8%. The bone fixation quality was good (26.6%) and not
good (13.1%). The rate of non-fixation of bone was 9.4%. The hemostasis
management quality was good (22.3%) and not good (15.9 %). The rate of
non-hemostasis management was 7.7%.
Pham Thi My Ngoc et al. (2013) evaluated the first aid status at the
accident place and showed that the software injury management was not
good (or not given first aid) (11.11%) and good or quite good (90%).


22
CONCLUSIONS
Through the study of 4918 cases of accidents with
musculoskeletal system fracture at the Military Hospital 103 in the period
from 2010 to 2014, we would like to have the following two conclusions:
1. Some epidemiological characteristics of musculoskeletal system
fracture
Traumatic accidents that cause fractures tend to increase during
the study period. The rate of men is double compare to women (69%
compared to 31%). The average age of female patients is higher than men
(46.7% compared to 36.5%), concentrating on farmer groups and
freelance workers. The cause of fracture is mainly due to traffic accidents
and living accidents (46.1% and 44.4%), the rate of fractures due to
traffic accidents is mainly from motorbike falls.
- Fractures due to accidental injuries often occur at the beginning
and end of the year (January, March, September and December). Usually
occurs in the evening, about 2pm-6pm hours (32.3%), while due to labor
and living, fracture accidents usually occur in the morning (5am - 11am).
- Among cases of musculoskeletal system fracture, the rate of
closed fracture was 74.9%, higher than the open fracture (25.1%).
Fracture of lower limb accounts for the highest rate of 54.2%; the upper
limb has a lower rate of 26.5%, the combined limb fracture rate is 2.8%.
Other fractures account for low rates (11.1% spine, 3.0% pelvis).
- 90.42% have 1 bone fracture; 8.03% broken 2 bones; 1.4%
broke 3 bones and 0.14% broke 4 or more bones. The combined lesions
of common four limbs fractures are articular fractures, major vascular
lesions and nerve damage, of which the upper limb ranges from 29.7% to
34.3%, the lower limb range from 26.1% to 32.7%. The rate of shock
injury of upper limb fracture is 5.1%; lower limb fracture is 6.2%; The
rate of shock injury of combine limb fracture was 24.6%.


23
2. Initial primary care situation of musculoskeletal system fracture
patients
The number of emergency patients at the Emergency Clinic is
64.6%; 25.6% at the branch level and 9.8% at the site of the accident.
The rate of patients that have emergency treatment within the first 5
minutes is 21.3%, later than 30 minutes is 26.2%. Transporting patients
from the accident site to the hospital by motorbike (54.8%), cars
(39.4%). Ambulance of 115 accounts for a low rate (1.6%). The first
person directly involved in emergency treatment of patients at the
accident site was mainly citizen (81.3%), participation of health workers
accounted for a low rate (18.7%).
- 85.1% of cases were given painkiller; 55.9% of open fractures
are bandaged; 87.8% are fixed broken bones; 17.9% used antibiotics and
SAT. The rate of closed fractures with standardize emergency treatment
is 11.8%, 88.5% at the branch level and 68.3% at the emergency room.
The percentage of open fractures with standardize emergency treatment
at the branch level was 19.5%, at the Emergency Clinic was 16.7%. The
rate of bandaging in cases of open fracture at the accident site is 55.2%;
the basic health care line is 45.5%, in emergency clinics 59.0%.
- 48.4% used medical braces, 51.6% used self-made braces;
92.1% of the brace is full length and 96.5% of the brace is stable. 85.1%
of cases were given painkillers, of which 19.3% used oral medicines,
80.7% used injections. The time of using painkillers was 56.1% used
before fixed and 43.9% used after fixed. 18.1% were given antibiotic
prophylaxis in open fractures, of which 8.8% were oral medicines and
91.2% were injected. The rate of using SAT in cases of open fracture at
the primary health level is 44.0% and in the Emergency Clinic is 60.9%,
there is no case of being used at the site of the accident.


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