ABSTRACT
In order to deal with the shortage of medical talents in Tibet, medical group assistance to Tibet is started as an innovative move in a new era, not only providing high-quality medical resources to Tibet, but also training local medical personnel by drawing on the "Master-Apprentice" model in traditional Chinese medicine. During the past three-year, the Shanghai Medical Team took advantage of medical group assistance to Tibet, enriched the types, methods and contents of teaching and mentoring tasks, and highlighted the role of "experts leading the backbone" and "team leading the team" in the "Master-Apprentice" model. The total amount and quality of local medical talents have thus been significantly improved. On the basis of summarizing experience, this study proposes a number of measures to optimize the current "Master-Apprentice" training model, evaluate the implementation process, and improve the feedback and quality management, so as to speed up the construction of the Tibetan medical talent team.
ABSTRACT
AIMS: The articular congruity of tibial plateau has been stressed to be associated with the long-term function outcomes. Approach selection and fixation pattern to manipulate the posterolateral (PL)-depression of tibial plateau are both key issues which trauma surgeons should focus on. In order to provide a strong purchase of PL-depression, we developed a new modified Frosch approach and a "Barrel hoop plate" technique to provide bony reconstruction of PL-depression. MATERIALS AND METHODS: Eleven consecutive patients of tibial plateau fractures involved in PL-depression were surgically treated at our single level-I trauma center. Our newly designed "Barrel hoop plate" was used to fix the PL-depression via a modified Frosch approach. The demography and treatment information were summarized of all the patients. X-ray and CT-scan of the knee joint were used to assess the reduction after operation. Besides evaluation of the HSS knee score, medial tibial plateau angle(mTPA), posterior slope angle(PSA) and articular step-off were measured to assess the malreduction degrees. RESULTS: The average operation time was 123 ± 20 min. The mean blood loss was 148 ± 45 mL. The fractures were healed radiographically at 13 ± 1 weeks post-operation. After 15 ± 2 months follow-up, all the patients were pain-free with full range of motion and stable knees. Radiologically, good fracture reduction was achieved in all cases. According to the final assessment, the mTPA, m-PSA and l-PSA were 85° ± 2°, 11° ± 5° and 10° ± 6°, respectively. The average range of motion was 128° ± 10°in flexion and 4° ± 4° in extension, and the average HSS score was 91 ± 3. CONCLUSION: Our new approach is a modification of the Frosch approach with a decreased soft tissue exposure and a low risk of neurovascular vessel injury. The concurrent application of the "Barrel hoop plate" technique could not only provide a reconstruction of the PL tibial plateau, but also hoop the ruptured tibia plateau rim and secure the depression as a raft. This new technique prevented the PL-tibial plateau reduction loss and the made the patients' early range of motion come true.
