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Life Cycle Assessment in Orthopedics 骨科生命周期评估
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-12-01 DOI: 10.1016/j.oto.2022.100998
Bella Pollice , Cassandra L. Thiel , Mark E. Baratz

Covid-19 has led to an increase in the use of PPE, gowns, masks, sanitizers, air circulators, and much more, all contributing to an increase in medical waste. Waste generation is one issue. Emissions are another. The two are linked because waste and emissions are both indicators of consumption. However, waste is not the biggest driver of environmental emissions for healthcare. It is the production of medical equipment, particularly disposables that have a bigger impact. Energy use during care, including heating and cooling our facilities, is another. Environmental emissions like greenhouse gases may not correlate with waste generation, especially if the waste is plastic. Carbon is stored in plastic. Unless you're burning plastic, you're not emitting carbon. Healthcare has a waste issue and healthcare has an emissions issue. They are not necessarily the same thing, however, the strategies to mitigate each overlap. Life cycle assessment quantifies emissions from the creation to disposal of medical supplies. This allows the medical community to make informed choices with respect to the methods and materials that are used in providing care. As other specialties take the lead in reducing their environmental footprint, so too, must orthopedic surgery.

Covid-19导致个人防护装备、防护服、口罩、消毒剂、空气循环器等的使用增加,所有这些都导致了医疗废物的增加。废物产生是一个问题。排放是另一个问题。这两者是联系在一起的,因为废物和排放都是消费的指标。然而,废物并不是医疗行业环境排放的最大驱动因素。医疗设备的生产,尤其是一次性设备的生产,影响更大。护理期间的能源使用,包括加热和冷却我们的设施,是另一个问题。温室气体等环境排放可能与废物产生无关,特别是如果废物是塑料的。碳储存在塑料中。除非你燃烧塑料,否则你不会排放碳。医疗保健存在废物问题,医疗保健存在排放问题。它们不一定是同一件事,但是,减轻每个重叠的策略。生命周期评估量化了从制造到处置医疗用品的排放。这使医学界能够在提供护理的方法和材料方面作出知情选择。在其他专业率先减少环境足迹的同时,整形外科也必须如此。
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引用次数: 1
Lost in the Ether: The Environmental Impact of Anesthesia 迷失在乙醚:麻醉对环境的影响
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-12-01 DOI: 10.1016/j.oto.2022.100997
Molly M. Herr , Rachel E. Outterson , Shreya Aggarwal

Health care systems contribute a significant amount of global greenhouse gas (GHG) emissions, and operating rooms are among the most resource intensive and waste producing locations in hospitals. Surgery's high environmental impact is due to many factors including: widespread use of anesthetic and medical gases; pharmaceutical production and waste; substantial non-recycled waste from disposable single-use devices; and energy consumption for equipment use and reprocessing, in addition to the significant energy needed for heating, cooling and ventilation of ORs. As the urgency of addressing global climate change increases, health care providers must do all they can to minimize the environmental impacts of health care in a sustainable, yet safe manner. Thoughtful management techniques by anesthesiologists, surgeons, and operating room staff before, during, and after procedures can minimize the environmental impact of surgery while maintaining cost-efficient, excellent patient care.

卫生保健系统对全球温室气体(GHG)排放有很大贡献,而手术室是医院中资源最密集和产生废物最多的场所之一。手术对环境的高影响是由于许多因素造成的,包括:麻醉剂和医用气体的广泛使用;药品生产和废弃物;一次性使用装置产生的大量非回收废物;以及设备使用和后处理的能源消耗,以及ORs的加热、冷却和通风所需的大量能源。随着应对全球气候变化的紧迫性日益增加,卫生保健提供者必须尽其所能,以可持续而安全的方式最大限度地减少卫生保健对环境的影响。麻醉师、外科医生和手术室工作人员在手术前、手术中和手术后采用周到的管理技术,可以最大限度地减少手术对环境的影响,同时保持成本效益和良好的患者护理。
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引用次数: 2
Environmental Sustainability in Orthopaedic Surgery – Where We Are and Where We Are Going 骨科手术中的环境可持续性-我们在哪里,我们要去哪里
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-12-01 DOI: 10.1016/j.oto.2022.100995
Ian D. Engler , Andrew J. Curley

“The triple bottom line” is an approach to mitigate the environmental consequences of any business endeavor by considering three important stakeholders - Profit, People, and Planet. While medicine is making appreciable progress on its environmental impact, the field of orthopaedic surgery is only beginning to research and prioritize environmental sustainability. Research, including Quality Improvement projects, is the avenue to understanding how to expand environmentally-conscious orthopaedic care. Research that identifies effective strategies for change cannot be effective without buy-in from medical staff, administrators, insurers, and governing bodies.

“三重底线”是一种通过考虑三个重要的利益相关者——利润、人和地球——来减轻任何商业努力对环境造成的后果的方法。虽然医学在其环境影响方面取得了可观的进展,但骨科手术领域才刚刚开始研究和优先考虑环境可持续性。研究,包括质量改进项目,是了解如何扩大环境意识骨科护理的途径。如果没有医务人员、管理人员、保险公司和管理机构的支持,确定有效变革战略的研究就不可能有效。
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引用次数: 1
Water – An Evaporating Resource 水——蒸发的资源
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-12-01 DOI: 10.1016/j.oto.2022.101000
Allison R. Mitchell , Jason R. Saleh

Humans are affected in numerous ways by climate change. Drought and water scarcity is an important area that must be addressed. Hospitals use a large amount of their community's water supply and therefore play a part in water conservation. The orthopaedist can minimize water waste in the operating room in multiple ways. The most immediate impact can be made by using less water for pre-operative scrubbing, either by turning off the water when not actively rinsing or by converting to waterless scrub. Eliminating rarely used surgical instruments from trays can save water and decrease costs to the hospital. Conserving water benefits both the hospital and the planet.

人类在许多方面受到气候变化的影响。干旱和缺水是必须解决的一个重要领域。医院使用大量的社区供水,因此在节约用水方面发挥了作用。骨科医生可以通过多种方式减少手术室的水浪费。最直接的影响可以通过减少术前洗涤用水来实现,要么在不主动冲洗时关闭水,要么改用无水洗涤。从托盘中去除很少使用的手术器械可以节约用水,降低医院的成本。节约用水对医院和地球都有好处。
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引用次数: 0
Contributors (pick up from previous issue w/updates) 贡献者(从以前的问题和更新中挑选)
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-09-01 DOI: 10.1053/S1048-6666(22)00049-0
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引用次数: 0
The Brostrom Procedure: Open Reconstruction of the Lateral Ankle Ligament Complex Brostrom手术:开放式踝关节外侧韧带复合体重建
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-09-01 DOI: 10.1016/j.oto.2022.100980
Paul G. Talusan

Ankle inversion injuries are common and most patients will have complete resolution of symptoms with nonoperative treatment. Some patients will develop chronic ankle instability and may develop associated pathology such as peroneal tendonitis, osteochondral lesions, ankle synovitis, and ankle impingement. A careful physical examination is imperative to evaluate for ankle instability as well as concomitant pathology. Imaging begins with standard radiographs and advanced imaging is used to evaluate for osteochondral lesions, ligament integrity, tendinitis, and other soft tissue lesions. Nonoperative treatment consists of immobilization, bracing, and physical therapy. Surgical treatment is reserved for patients who have symptoms despite nonoperative treatment and often involves imbrication of the lateral ankle ligament complex. Outcomes are typically favorable and most patients can expect to return to athletic activity.

踝关节内翻损伤是常见的,大多数患者可以通过非手术治疗完全解决症状。一些患者会发展为慢性踝关节不稳定,并可能发展为相关病理,如腓骨肌腱炎、骨软骨病变、踝关节滑膜炎和踝关节撞击。仔细的体格检查是必要的,以评估踝关节不稳定以及伴随的病理。影像学从标准x线片开始,高级影像学用于评估骨软骨病变、韧带完整性、肌腱炎和其他软组织病变。非手术治疗包括固定、支具和物理治疗。手术治疗保留给非手术治疗后仍有症状的患者,通常涉及踝关节外侧韧带复合体的阻塞。结果通常是有利的,大多数患者可以期望恢复体育活动。
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引用次数: 0
Arthroscopic Ankle Lateral Ligament Repair for Chronic Lateral Ankle Instability 关节镜下踝关节外侧韧带修复慢性踝关节外侧不稳
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-09-01 DOI: 10.1016/j.oto.2022.100982
Masato Takao , Mark Glazebrook

Minimally Invasive lateral ligament repair of the ankle has been developed in recent years. These repairs involve threading sutures to the remnant and can be classified into three types. These include arthroscopy-assisted mini-open procedure, arthroscopic with percutaneous procedure, and all-inside arthroscopic procedures. The all-inside arthroscopic procedure is the most minimally invasive procedure because all steps are performed arthroscopically through one portal. Further, since it is possible to suture the ligament with a direct arthroscopic view all-inside arthroscopic procedures can be performed anatomically. In this chapter, the authors provide the history of arthroscopic lateral ankle ligament repair and a recommended procedure for all-inside arthroscopic ankle lateral ligament repair using a modified lasso-loop stitch technique.

踝关节外侧韧带的微创修复是近年来发展起来的。这些修复包括对残肢进行穿线缝合,可分为三种类型。这些包括关节镜辅助的小开放手术、经皮关节镜手术和全内关节镜手术。全内关节镜手术是最微创的手术,因为所有步骤都是通过一个门静脉进行的。此外,由于可以在直接关节镜下缝合韧带,因此可以从解剖角度进行全内关节镜手术。在本章中,作者提供了关节镜下踝关节外侧韧带修复的历史,并推荐了采用改良的套索环缝合技术进行全内关节镜下踝关节外侧韧带修复的程序。
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引用次数: 0
Techniques for Cavovarus Foot Reconstruction with Concomitant Ankle Instability 伴有踝关节不稳的卡沃内足重建技术
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-09-01 DOI: 10.1016/j.oto.2022.100985
Todd A. Irwin MD

Patients who present with lateral ankle ligament instability always need to be evaluated for cavovarus foot deformity. Cavovarus reconstruction may need to be performed in order to ensure the ankle instability procedure is successful. Which procedures are required will depend on the specific deformity present, and may need to be determined intraoperatively depending on the initial deformity correction achieved through the first procedures performed. A general though not strict algorithm for sequence of procedures involves soft tissue releases first, followed by hindfoot correction, then forefoot correction, and securing ligament reconstruction or tendon transfers as the final step. Tendon transfers can be an effective tool to aid in the deformity correction and several are described. For hindfoot and forefoot deformity correction, traditional calcaneus and metatarsal osteotomies work well, but fusion should be considered for joints with degenerative change or in cases where the deformity is severe or can't be corrected through osteotomy alone.

表现为踝关节外侧韧带不稳的患者需要对其进行足畸形评估。为了确保踝关节失稳手术的成功,可能需要进行卡沃内翻重建。需要采用哪种手术将取决于具体的畸形,并且可能需要在术中确定,这取决于通过第一次手术实现的初始畸形矫正。一般但不严格的手术顺序算法包括首先软组织释放,然后是后脚矫正,然后是前脚矫正,最后一步是固定韧带重建或肌腱转移。肌腱转移可以是一个有效的工具,以帮助在畸形矫正和几个描述。对于后脚和前脚畸形矫正,传统的跟跖截骨术效果良好,但对于退行性变关节或畸形严重或仅靠截骨术无法矫正的情况,应考虑融合。
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引用次数: 1
Table of Contents (pick up from previous issue w/updates) 目录(选自上一期的内容和更新)
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-09-01 DOI: 10.1053/S1048-6666(22)00048-9
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引用次数: 0
Editorial Board (pick up from previous issue w/updates) 编辑委员会(选自上一期,并有更新)
IF 0.1 Q4 ORTHOPEDICS Pub Date : 2022-09-01 DOI: 10.1053/S1048-6666(22)00047-7
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引用次数: 0
期刊
Operative Techniques in Orthopaedics
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