【摘要】 目的 了解新护士的心理健康状况及应付方式。 方法 采用心理卫生自评量表（SCL-90）和应付方式量表对2008年1月-2009年12月新上岗的64名护士进行测查。 结果 新护士强迫症状、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分、总均分及阳性项目数与全国常模比较偏高，差异有统计学意义（Plt;0.05）；SCL-90阳性者与阴性者应付方式比较，阳性者自责、幻想、退避、合理化因子均分均高于阴性者，差异有统计学意义（Plt;0.01）；新护士应付方式各因子均分、退避、幻想、自责因子均高于吴超等人的研究（Plt;0.05）。 结论 新护士心理健康状况低于一般人群；较其他年龄段护士更多采用不成熟应付方式；成熟应付方式有益心理健康。护理管理者应重视新护士心理健康，引导新护士多采取成熟应付方式，提高心理健康水平。【Abstract】 Objective To evaluate the psychological states of new nurses and their coping styles. Methods Sixty-four nurses starting work between January 2008 and October 2009 in our hospital were investigated by Symptom Checklist 90 (SCL-90) and Coping Style Questionnaire. Results The scores of compulsion and mental disorder, average score, and the number of positive items were statistically higher than the national norm of China (Plt;0.001). The scores of athymia, anxiety, hostility, and phobia factors were higher than the national norm (Plt;0.01). The score of paranoid factor was also statistically higher than the national norm (Plt;0.05). Based on the results of SCL-90, we found that the scores of factors of self-accusation, fantasy, back-off (Plt;0.05) and the factor of rationalization (Plt;0.01) in the positive group were significantly higher than those of the negative group. Compared with the result of the research made by WU Chao and his colleges, the average scores of such factors as back-off (Plt;0.001), fantasy (Plt;0.01) and self-accusation (Plt;0.05) were statistically higher in the study group than those in the control group. Conclusion The psychological states of new nurses are worse than the general population. Compared with older nurses, new nurses are more inclined to use immature coping styles. Mature coping styles are favorable to their psychological states. The nursing regulators should pay more attention to the psychological states of new nurses and guide them to use mature coping styles to improve their psychological states.
Objective To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group (P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group (Z=–2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation (t=2.98, P=0.01). Conclusion The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.
Objective To compare the effectiveness of three surgical methods in the treatment of Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients, in order to provide reference for clinical selection of appropriate surgical methods. Methods The clinical data of 103 patients with Pauwels type Ⅲ femoral neck fracture who met the selection criteria between June 2018 and December 2021 were retrospectively analyzed. The fractures were fixed with hollow screws in an inverted triangular shape (37 cases, hollow screw group), hollow screws in an inverted triangular shape combined with eccentric shaft screw (34 cases, eccentric shaft screw group), and hollow screws in an inverted triangular shape combined with medial support plate (32 cases, support plate group). There was no significant difference in age, gender, cause of injury, body mass index, time from injury to operation, side of the fracture, and Garden classification, whether they were in traction preoperatively, and other baseline data between groups (P>0.05). The operation time, intraoperative blood loss, the number of fluoroscopy, the length of hospital stay, early postoperative complication and postoperative weight-bearing time of the three groups were recorded. Harris score was used to evaluate joint function at 6 and 12 months after operation, and the difference between the two time points (change value) was calculated for comparison between groups. X-ray films were reviewed to evaluate the quality of fracture reduction (Garden index) and healing, as well as the occurrence of internal fixation failure and femoral head necrosis. Results The patients of the three groups were successfully completed. Compared with the hollow screw group and the eccentric shaft screw group, the operation time and intraoperative blood loss of the support plate group significantly increased, the number of fluoroscopy reduced, and the quality of fracture reduction was better, the differences were significant (P<0.05). The operation time, intraoperative blood loss, and the number of fluoroscopy of the hollow screw group were less than those of the eccentric shaft screw group, the differences were significant (P<0.05). There was no significant difference in the length of hospital stay between groups (P>0.05). All patients in the three groups were followed up 21-52 months, with an average follow-up time of 36.0 months, and there was no significant difference between groups (P>0.05). The incisions of all patients healed by first intention. Imaging reexamination showed that there was no significant difference in the incidence of fracture nonunion between groups (P>0.05). The fracture healing, partial weight-bearing, and full weight-bearing were significantly earlier in the eccentric shaft screw group and the support plate group than in the hollow screw group (P<0.05). There was no significant difference in change value of Harris score, the incidence of postoperative deep venous thrombosis and femoral head necrosis between groups (P>0.05); however, the incidence of internal fixation failure in the support plate group and the eccentric shaft screw group was significantly lower than that in the hollow screw group (P<0.05). The incidence of postoperative lateral thigh irritation in the support plate group was significantly lower than that in the hollow screw group (P<0.05); there was no significant difference between the eccentric shaft screw group and the other two groups (P>0.05). The overall incidences of postoperative complications in the eccentric shaft screw group and the support plate group were significantly lower than that in the hollow screw group (P<0.05). Conclusion For young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture, compared with simple hollow screw fixation in an inverted triangular shape, combined with medial support plate or eccentric shaft screw internal fixation can shorten the fracture healing time, reduce the incidences of postoperative complication, more conducive to early functional exercise of the affected limb; at the same time, the operation time and blood loss of combined eccentric shaft screw internal fixation are less than those of combined medial support plate internal fixation, so the hollow screw in an inverted triangular shape combined with eccentric shaft screw fixation may be a better choice.