全膝关节置换术治疗膝关节周围骨肿瘤的手术配合及护理探讨
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摘要
目的探讨全膝关节置换术治疗膝关节周围骨肿瘤的手术配合及护理情况,提高技术配合水平。方法回顾性分析102例膝关节周围骨肿瘤患者的临床资料,观察全膝关节置换术后膝关节周围骨肿瘤患者的术中配合情况和对其手术前后的访视结果。结果 102例膝关节周围骨肿瘤患者术后1 h的疼痛评分为(3.31±0.03)分,术后1 d的疼痛评分为(2.78±0.10)分,术后3 d的疼痛评分为(2.40±0.23)分,患者术后1、3 d的疼痛程度均较术后1 h的疼痛程度明显减轻(P﹤0.01);术后,患者的焦虑、抑郁评分分别为(31.10±3.11)分、(33.25±3.07)分,均明显低于术前的(47.10±2.86)分、(49.36±2.27)分(P﹤0.01)。全部患者均获得随访,随访时间为6~12个月。采用美国特种外科医院(HSS)膝关节评分标准对膝关节功能进行评价:优52例,占51.0%(52/102);良50例,占49.0%(50/102);中0例,占0(0/102);差0例,占0(0/102);优良率为100%(102/102)。结论术前进行个体化心理护理,术中密切配合、严格执行操作规程,术后综合护理,可缓解行全膝关节置换术的膝关节周围骨肿瘤患者的心理压力,减轻患者的术后疼痛,促进患者病情的康复。
Objective To investigate the surgical cooperation and nursing of total knee arthroplasty in the treatment of bone tumors around the knee joint. Method The clinical data of 102 patients with bone tumor around the knee joint were analyzed retrospectively. The intraoperative cooperation and the results of pre-and post-operation visits of total knee arthroplasty were investigated. Result The pain scores of 102 patients on the 1 st hour, the 1 st day and the 3 rd day were(3.31±0.03),(2.78±0.10) and(2.40±0.23), respectively; and the pain scores on the 1 st day and the 3 rd day were significantly decreased compared with that on the 1 st hour(P<0.01). After operation, the scores of anxiety and depression were(31.10±3.11) and(33.25±3.07), which were significantly lower than those(47.10±2.86) and(49.36±2.27) before the operation(P<0.01). All patients completed the follow-up for 6-12 months, American Hospital for Special Surgery(HSS) knee score criteria was used to assess the knee function: 52(51.0%) cases were excellent, 50(49.0%) cases were good, 0(0)cases was medium, 0(0) cases was poor, and fine rate was 100%(102/102). Conclusion The patient's psychological pressure and postoperative pain can be relieved by preoperative individualized psychological nursing, the close coordination during the operation, the strict implementation of operating procedures and postoperative comprehensive care, which can also promote the rehabilitation of the disease.
Objective To investigate the surgical cooperation and nursing of total knee arthroplasty in the treatment of bone tumors around the knee joint. Method The clinical data of 102 patients with bone tumor around the knee joint were analyzed retrospectively. The intraoperative cooperation and the results of pre-and post-operation visits of total knee arthroplasty were investigated. Result The pain scores of 102 patients on the 1 st hour, the 1 st day and the 3 rd day were(3.31±0.03),(2.78±0.10) and(2.40±0.23), respectively; and the pain scores on the 1 st day and the 3 rd day were significantly decreased compared with that on the 1 st hour(P<0.01). After operation, the scores of anxiety and depression were(31.10±3.11) and(33.25±3.07), which were significantly lower than those(47.10±2.86) and(49.36±2.27) before the operation(P<0.01). All patients completed the follow-up for 6-12 months, American Hospital for Special Surgery(HSS) knee score criteria was used to assess the knee function: 52(51.0%) cases were excellent, 50(49.0%) cases were good, 0(0)cases was medium, 0(0) cases was poor, and fine rate was 100%(102/102). Conclusion The patient's psychological pressure and postoperative pain can be relieved by preoperative individualized psychological nursing, the close coordination during the operation, the strict implementation of operating procedures and postoperative comprehensive care, which can also promote the rehabilitation of the disease.
引文
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[14]宋雯,余华晨.术中舒适护理对人工全膝关节置换术患者术后疼痛及膝关节功能的影响[J].中国现代医生,2015,53(26):151-153.
[15]杨菊莲,陈利明,唐国琼,等.人工全全膝关节置换术后早期康复护理效果观察[J].西部医学,2014,26(8):1082-1083.
[16]温国仪.系统护理在全膝关节置换术后镇痛中的应用[J].护理实践与研究,2017,14(11):116-118.
[17]卢玉彬,尹晓莉.全膝关节置换术后早期引入临床康复护理路径的效果评价[J].护士进修杂志,2017,32(12):1074-1077.
[18]王海芬,仲艳,樊丽洁,等.以信息-动机-行为技巧模型为理论基础的干预护理在老年膝关节置换中的应用[J].山西医药杂志,2017,46(19):2395-2398.
[19]邓永鸿,张慧,曾子,等.加速康复外科护理对全膝关节置换术患者膝关节功能影响的系统评价[J].护理学报,2017,24(12):27-32.
[20]赵一琼,施雁.运动想象疗法联合平衡力锻炼在全膝关节置换术后病人中的应用[J].护理研究,2017,31(29):3716-3719.
[2]曾艳.特制型人工膝关节置换治疗膝关节周围恶性骨肿瘤的护理[J].当代护士(上旬刊),2016(2):93-95.
[3]李华,陈婧,张红,等.膝旁骨肿瘤人工全膝关节置换术后功能锻炼表的应用价值[J].浙江临床医学,2015,17(4):618-620.
[4]Delepine G,Delepine N,Goutallier D.Allograft prosthetic reconstruction:review of 120 composite prostheses(1984–1992),a monocentric study[M].Springer Vienna:Orthopaedic Allograft Surgery,1996:165-174.
[5]刘雪梅.人工全膝关节置换术后感染的预防护理措施[J].临床合理用药杂志,2014,7(10):54-56.
[6]才智,马峰,郭成安,等.膝周骨肿瘤保肢手术并发症的探讨[J].河北医药,2015,37(18):2827-2828.
[7]薛英森,王臻,李晓博,等.膝关节周围恶性骨肿瘤保肢治疗短期疗效回顾性分析[J].中国骨与关节杂志,2017,6(6):428-432.
[8]甘玉云,代极静,刘星,等.医麻护三位一体疼痛管理模式在全膝关节置换术患者围手术期的效果研究[J].护士进修杂志,2016,31(9):807-810.
[9]Xu S,Yu X,Xu M,et al.Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur[J].BMC Musculoskelet Disord,2014,15:453.
[10]戴颖.个性化护理干预对人工全膝关节置换术患者术后膝关节功能康复的效果观察[J].现代妇女:医学前沿,2014(3):79-79.
[11]荆琳,张洪美,韩露,等.全全膝关节置换术治疗膝关节恶性骨肿瘤[J].中华骨与关节外科杂志,2015,8(5):425-428.
[12]Nakamura T,Matsumine A,Uchida A,et al.Clinical outcomes of kyocera modular limb salvage system after resection of bone sarcoma of the distal part of the femur:the Japanese Musculoskeletal Oncology Group study[J].Int Orthop,2014,38(4):825-830.
[13]张卫华,周红梅,程娟.老年人全全膝关节置换术的手术配合和护理[J].当代护士(中旬刊),2014,(3):79-80.
[14]宋雯,余华晨.术中舒适护理对人工全膝关节置换术患者术后疼痛及膝关节功能的影响[J].中国现代医生,2015,53(26):151-153.
[15]杨菊莲,陈利明,唐国琼,等.人工全全膝关节置换术后早期康复护理效果观察[J].西部医学,2014,26(8):1082-1083.
[16]温国仪.系统护理在全膝关节置换术后镇痛中的应用[J].护理实践与研究,2017,14(11):116-118.
[17]卢玉彬,尹晓莉.全膝关节置换术后早期引入临床康复护理路径的效果评价[J].护士进修杂志,2017,32(12):1074-1077.
[18]王海芬,仲艳,樊丽洁,等.以信息-动机-行为技巧模型为理论基础的干预护理在老年膝关节置换中的应用[J].山西医药杂志,2017,46(19):2395-2398.
[19]邓永鸿,张慧,曾子,等.加速康复外科护理对全膝关节置换术患者膝关节功能影响的系统评价[J].护理学报,2017,24(12):27-32.
[20]赵一琼,施雁.运动想象疗法联合平衡力锻炼在全膝关节置换术后病人中的应用[J].护理研究,2017,31(29):3716-3719.