目的:探讨术后早期康复护理干预对骨盆恶性肿瘤半骨盆切除、组合式半骨盆+全髋关节置换术后的患肢功能的影响。方法：从2004年9月至2007年5月采用半骨盆切除、组合式半骨盆假体+全髋关节置换术治疗骨盆恶性骨肿瘤8例。其中软骨肉瘤4例，平滑肌肉瘤2例，骨肉瘤1例，恶性骨巨细胞瘤1例。外科分期:ⅠB期6例，ⅡB期2例。术后根据肿瘤切除范围、人工假体置换术后稳定性和骨盆髋周动力肌修复后的平衡程度，决定术后患肢体位、患髋活动范围、是否使用髋部支具；同时指导患者分阶段、渐进地进行患肢足踝、膝、髋关节的主被动训练，以及下床负重时间和步态调整。结果：随访10～32个月，平均15月。1例术后16个月死于恶性肿瘤扩散转移，7例存活。术后8个月患肢功能评定:优2例，良6例。ISOLS评分:15～26分，平均19.47分。结论：①对骨盆恶性骨肿瘤患者积极进行术后早期康复护理干预能有效的防止人工髋关节早期脱位；②患肢各关节分阶段有序的主动康复护理训练能提高骨盆和髋周肌肉肌力及其平衡度，对维持术后患者行走和步态的稳定有重要意义。
目的:探讨公共突发事件中大批量收治伤员时的骨科护理管理流程。方法:对汶川地震期间,四川大学华西医院骨科收治1 410名骨科地震伤员时包括紧急组织管理、护理人力资源管理、护理流程革新以及信息管理等的护理管理进行总结、分析、评价。结果:通过高效的护理应急管理,保证了在汶川地震灾害救援中的医疗、护理质量,提高了伤员的整体救护水平。结论:医院建立有效的应急管理体系,通过各部门配合,再造护理管理流程,在灾害医疗救援中具有重要意义。
Objective To explore the effect of a teamwork intervention during their rehabilitation process for patients who had undergone an amputatation after an earthquake. Methods A total of 85 patients undergoing amputation were included in the study. A rehabilitation team consisting of orthopaedic doctors, orthopaedic nurses, physical therapists, professional therapists, psychology consultants, volunteers, social workers, patients and their relatives participated in the comprehensive rehabilitation program. The outcome of this teamwork intervention was evaluated. Results Statistically significant improvement was observed in terms of patients’ physiological, psychological and social roles after the teamwork intervention ( Plt;0.05). Conclusion The teamwork intervention can improve the overall outcome of rehabilitation, including quality of life, in amputated patients following an earthquake.
ObjectiveTo investigate the effect of different use time of intermittent pneumatic compression (IPC) on the incidence of deep vein thrombosis (DVT) of lower extremities after arthroplasty.MethodsBetween October 2018 and February 2019, 94 patients who planned to undergo unilateral total hip or knee arthroplsty and met the selection criteria were randomly divided into a control group (47 cases) and a trial group (47 cases). There was no significant difference in gender, age, surgical site, and surgical reason between the two groups (P>0.05). After returning to the ward, all patients were treated with IPC. And the IPC was used until 9:00 pm on the day after operation in the trial group and until 8:00 am the next day after operation in the control group. The levels of hemoglobin, platelet count, D-dimer, hospital stay, treatment costs, patients’ satisfaction with IPC, the parameters of thromboelastrography [kinetics (K value), freezing angle (α angle), reaction time (R value), maximum amplitude (MA value)], visual analogue scale (VAS) score, circumference difference of calf before and after operation, Pittsburgh sleep assessment score, and the incidence of DVT of lower limbs were recorded and compared between the two groups.ResultsThe K value and D-dimer before operation were significant different between the two groups (P<0.05). There was no significant difference in pre- and post-operative hemoglobin, platelet count, and the other parameters of thromboelastography between the two groups (P>0.05). There was no significant difference in pre- and post-operative VAS scores and post-operative circumference difference of calf between the two groups (P>0.05). The sleep assessment score of the trial group at 1 day after operation was significant lower than that of the control group (t=2.107, P=0.038). There was no significant difference in the hospital stay and treatment costs between the two groups (P>0.05). There was 1 case (2.1%) of DVT, 3 cases (6.4%) of intermuscular venous thrombosis, and 1 case (2.1%) of infection in the trial group, and 2 cases (4.3%), 4 cases (8.5%), and 0 (0) in the control group. The differences were not significant (P>0.05). After the completion of postoperative IPC treatment, the satisfaction rates of using IPC were 89.4%(42/47) in the trial group and 70.2% (33/47) in the control group, and the difference was not significant (χ2=0.097, P=0.104).ConclusionIPC using for a short period of time after arthroplasty do not increase the degrees of the pain and the swelling of calf; it can effectively prevent DVT of the lower extremity, improve the quality of sleep in patients, and is good for the limbs rehabilitation.