生理盐水与75%乙醇护理经皮骨穿针针道效果比较

目的评价生理盐水按需护理经皮骨穿针针道的效果,提高患者治疗舒适度。方法将220例骨科住院行经皮骨穿针外固定或骨牵引的患者按时间段分为对照组100例、观察组120例。对照组按常规护理及于针孔处每天2次外滴75%乙醇,针道口如有渗血渗液,用75%乙醇棉签消毒针道后更换纱条;观察组不予外滴药物或消毒剂,针道口如有渗血渗液,采用生理盐水清洁针道口后更换纱条。结果观察组针道感染率及针道护理时不适度显著低于对照组(均P0.01)。结论对留置经皮骨穿针患者,采用生理盐水清除针道分泌物及按需护理,可降低针道感染率及提高患者治疗舒适度。     

非药物疗法在小儿烧伤疼痛管理中的应用

目的 探讨非药物疗法对小儿烧伤疼痛的影响.方法 将60例住院烧伤患儿随机分为观察组和对照组各30例.对照组给予烧伤科常规护理;观察组在此基础上融入非营养性吸吮、实施"便利蜷曲"法体位、袋鼠式护理、含蔗糖饮料、音乐疗法等非药物疗法镇痛.采用FLACC量表评估两组患儿清创换药、静脉穿刺等有创操作后的疼痛评分,并比较两组患儿留置针保留时间.结果 观察组患儿有创操作后FLACC评分及留置针保留时间显著优于对照组(均P<0.01).结论 非药物疗法可降低小儿烧伤后有创操作性疼痛,延长静脉留置时间,减轻患儿痛苦.     

克氏针可调节固定装置于下肢骨牵引中的临床应用

目的 设计一种克氏针可调节固定装置，并观察其应用于下肢骨牵引的效果。方法 选取2020年4月至2021年10月解放军总医院第一医学中心创伤骨科收治的168例行下肢骨牵引治疗的患者，根据随机数字表法分为观察组和对照组各84例。对照组给予实施常规的骨牵引护理，其中男47例，女37例；年龄22～67岁，平均(41.5±6.5)岁。观察组患者在原有克氏针上使用可调节固定装置，其中男49例，女35例；年龄18～65岁，平均(38.7±7.3)岁。术后评价克氏针偏移发生率和克氏针感染发生率，患者疼痛程度采用疼痛视觉模拟评分(visual analogue scale, VAS)评价。结果 观察组患者克氏针偏移发生率、感染发生率、无效牵引发生率、VAS评分均明显低于对照组，差异有统计学意义(P<0.05)。结论 克氏针可调节固定装置能够增强骨牵引的稳定性，为骨牵引患者专科护理提供有效的临床依据。     

咪达唑仑术前干预对七氟烷全麻患儿苏醒期躁动及PACU滞留时间的影响

目的探讨咪达唑仑术前干预对七氟烷全麻患儿苏醒期躁动(EA)及PACU滞留时间的影响。方法随机将75例行白内障手术的患儿分为3组,各25例。对照组术前予以安慰剂,观察Ⅰ组、Ⅱ组术前分别予以高、低剂量的咪达唑仑。比较3组入室时镇静满意率、EA发生率、PACU滞留时间、手术时间、FLACC疼痛评分。结果观察Ⅰ组、Ⅱ组入室时镇静满意率均明显高于对照组(P 0. 05),但观察组间的差异无统计学意义(P 0. 05); 3组EA发生率、手术时间及入PACU后前30 min FLACC疼痛评分差异无统计学意义(P 0. 05)。观察I组PACU滞留时间明显长于Ⅱ组和对照组(P 0. 05),但观察Ⅱ组与对照组的差异无统计学意义(P 0. 05)。结论咪达唑仑术前干预能有效减轻入室时患儿的焦虑情绪,但无法降低七氟烷的EA率。高剂量咪达唑仑可增加PACU滞留时间。     

阅读疗法在儿童阴茎术后疼痛控制中的应用

目的 探讨阅读疗法在儿童阴茎术后疼痛控制中的应用效果.方法 将95例学龄期阴茎术后患儿随机分成观察组(46例)与对照组(49例),对照组采用常规护理,观察组在常规护理基础上增加阅读疗法.比较两组术后疼痛程度.结果 两组患儿术后疼痛评分比较,差异无显著性意义(P>0.05);观察组术后镇痛药使用率显著低于对照组(P<0.01).结论 阅读疗法可以减轻患儿阴茎术后疼痛程度,减少术后镇痛药使用率,有利于患儿术后康复.     

微创截骨Ilizarov技术结合髓内钉行股骨延长的疗效观察北大核心CSCD

目的探讨微创截骨Ilizarov技术结合髓内钉进行股骨延长治疗股骨短缩畸形的效果。方法将2013年1月—2016年6月收治并符合选择标准的71例股骨短缩畸形患者,随机分为试验组(36例,采用微创截骨Ilizarov技术结合带锁髓内钉进行股骨延长)和对照组(35例,采用单纯Ilizarov技术进行股骨延长)。两组患者年龄、性别、股骨短缩原因、股骨短缩长度、股骨合并畸形比例等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、延长速度、外固定器佩戴时间、针道感染例数、截骨愈合时间、术后1年膝关节活动度。结果两组患者均获随访,随访时间12～60个月,平均31个月。试验组1例1针、对照组7例9针发生针道感染,均经更换固定针、积极换药、使用抗生素及加强护理后治愈;两组针道感染发生率比较差异有统计学意义(χ~2=5.265,P=0.022)。试验组手术时间长于对照组,术中出血量大于对照组,外固定器佩戴时间、截骨愈合时间及术后1年膝关节活动度均优于对照组,差异有统计学意义(P<0.05);两组延长速度比较差异无统计学意义(t=-1.581,P=0.153)。结论微创截骨Ilizarov技术结合髓内钉进行股骨延长虽然增加了手术时间及术中出血量,但显著缩短了患者佩戴外固定器的时间,减少了针道感染概率,改善了术后关节功能。     

微创截骨Ilizarov技术结合髓内钉行股骨延长的疗效观察

目的探讨微创截骨Ilizarov技术结合髓内钉进行股骨延长治疗股骨短缩畸形的效果。方法将2013年1月—2016年6月收治并符合选择标准的71例股骨短缩畸形患者,随机分为试验组(36例,采用微创截骨Ilizarov技术结合带锁髓内钉进行股骨延长)和对照组(35例,采用单纯Ilizarov技术进行股骨延长)。两组患者年龄、性别、股骨短缩原因、股骨短缩长度、股骨合并畸形比例等一般资料比较差异均无统计学意义(P0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、延长速度、外固定器佩戴时间、针道感染例数、截骨愈合时间、术后1年膝关节活动度。结果两组患者均获随访,随访时间12～60个月,平均31个月。试验组1例1针、对照组7例9针发生针道感染,均经更换固定针、积极换药、使用抗生素及加强护理后治愈;两组针道感染发生率比较差异有统计学意义(χ~2=5.265,P=0.022)。试验组手术时间长于对照组,术中出血量大于对照组,外固定器佩戴时间、截骨愈合时间及术后1年膝关节活动度均优于对照组,差异有统计学意义(P0.05);两组延长速度比较差异无统计学意义(t=-1.581,P=0.153)。结论微创截骨Ilizarov技术结合髓内钉进行股骨延长虽然增加了手术时间及术中出血量,但显著缩短了患者佩戴外固定器的时间,减少了针道感染概率,改善了术后关节功能。     

应用儿童疼痛行为量表比较腹腔镜与开放小儿腹股沟斜疝手术术后疼痛

目的:应用儿童疼痛行为量表(FLACC)比较腹腔镜与传统疝囊高位结扎术治疗小儿腹股沟斜疝的术后疼痛。方法:选择2018年1月至12月收治的60例腹股沟斜疝患儿,患儿10个月～5岁2个月,按照随机数字表法将患者分为两组,观察组(n=30)采用双钩疝钩针法行腹腔镜疝囊高位结扎术,对照组(n=30)行传统开放经腹股沟管疝囊高位结扎术,分别于麻醉清醒后4 h(T_1)、8 h(T_2)、24 h(T_3)应用FLACC进行疼痛程度的评估。结果:T_1、T_2、T_3时,观察组FLACC评分为(5.73±1.29)、(3.20±1.27)、(1.50±0.73),对照组为(6.43±0.97)、(3.80±0.93)、(1.93±0.79),各时点观察组疼痛程度轻于对照组,差异有统计学意义(P0.05)。结论:与传统手术相比,腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝可有效减轻术后疼痛,创伤小,值得临床推广。     

胫骨横向骨搬移技术治疗糖尿病足的并发症分析

目的探讨胫骨横向骨搬移(tibial transverse transport,TTT)技术治疗糖尿病足的并发症发生原因及处理方法。方法回顾性分析2015年9月—2019年9月应用TTT技术治疗的196例糖尿病足患者临床资料。其中男109例,女87例;年龄45～86岁,平均67.6岁。糖尿病足根据Wagner分级法:3级124例,4级62例,5级10例;病程1～12个月,平均2.6个月。采用小切口微创胫骨截骨,其中62例于胫骨中下段截骨、134例于胫骨中上段截骨;83例截骨面积为20 cm~2、113例为7.5 cm~2。术后92例单次往返搬移、104例两次往返搬移。记录患者并发症发生情况,包括胫骨截骨处继发骨折、截骨区域皮肤坏死、针道感染,并对发生率进行统计分析。结果 196例患者中41例(20.9%)发生并发症。9例(4.6%)发生胫骨截骨处继发骨折;其中,胫骨中下段截骨者6例(9.6%)、中上段截骨者3例(2.2%),不同截骨部位患者间发生率差异有统计学意义(χ~2=5.354,P=0.021);截骨面积为20 cm~2者5例(6.0%)、7.5 cm~2者4例(3.5%),不同截骨面积患者间发生率差异无统计学意义(χ~2=0.457,P=0.499)。12例发生截骨区域皮肤坏死,发生率为6.1%,均为单次往返搬移患者;单次、两次往返搬移患者间发生率差异有统计学意义(P=0.001)。18例(9.1%)发生针道感染,其中轻度感染12例(6.1%)、重度感染6例(3.0%)。轻度、重度感染发生率差异无统计学意义(P=0.107)。结论 TTT技术是治疗糖尿病足的一种有效手段,但在骨搬移过程中存在胫骨截骨部位骨折、截骨区域皮肤坏死、针道感染等并发症发生风险。术前适应证评估,规范术中截骨方式、截骨块大小及位置,以及术后制定个性化骨搬移方案、加强针道护理,可有效减少并发症的发生。     

儿童腹股沟疝围手术期品管圈护理效果分析

目的分析与探讨儿童腹股沟疝围手术期应用品管圈护理的临床效果。方法选取2012年8月至2013年8月,河南省濮阳市人民医院收治儿童腹股沟疝患者128例,随机将其分为二组,观察组应用品管圈护理,对照组应用常规护理。比较二组患儿护理后的疼痛评分、并发症发生率、护理满意度以及各项临床指标。结果观察组通过品管圈小组护理后,二组患儿下床活动时间与住院时间差异有统计学意义（t=14．898、11．673,P=0．0001、0．0001）。观察组疼痛评分较对照组患儿更低,二组差异有统计学意义（,=13．333、9．425、4．910、10．046,P：0．0001、0．0001、0．0008、0．0001）。观察组并发症发生率明显低于对照组（X2=16．667,P=0．0001）,护理满意度与临床指标明显优于对照组,差异有统计学意义（t=49．331,P=0．0001）。结论品管圈护理对于儿童腹股沟疝围手术期具有重要的临床价值,能够有效控制患儿的疼痛感,并降低并发症发生率,提高护理满意度,缩短住院时间。     

Local antibiotics: panacea for long term skeletal traction

Long periods of skeletal traction are frequently needed in busy tertiary centres due to long waiting lists for surgery. A frequent complication is pin track infection, which leads to revision of pin insertion or switching over to skin traction. A prospective study was conducted on sixty patients with upper tibial pin insertion for various causes. Antibiotic (injection Cephazolin 0.5 g after sensitivity testing--250 mg on each side) was injected on thirty patients at the site of pin insertion and no antibiotic was injected in 30 controls. Only one stage one pin track infection was seen in the study group (3% cases), where as six cases had stage 1 infection, one case had stage 2 infection and two cases had stage 3 infections in the control group (30% cases). This study showed the usefulness of this modification in preventing morbidity in patients who are planned for long-term skeletal traction by temporarily suppressing the local flora.     

A prospective comparative study of pin site infection in pediatric supracondylar humeral fractures: daily pin care vs. no pin care

Introduction

Pin site infection is a critical issue for patients’ safety in skeletal fixation using percutaneous pins or wires. Closed reduction and percutaneous Kirschner wires fixation are the mainstay of treatment in pediatric supracondylar humeral fractures. Little information is available in the literature about the optimal regimen of pin site care in children.

Materials and methods

We performed a prospective comparative study of 61 children with supracondylar humeral fractures between June 2011 and March 2013 after approval by the institutional review board. They were allocated into two groups of different postoperative pin site care methods by the emergency department arrival date and received fracture fixation within 24 h. Postoperatively, 30 children underwent pin site cleaning every day whereas the other 31 patients did not have the pin sites cleaned until the pins removal 4–6 weeks later.

Results

Demographic data were not significantly different between the two groups. The infection rate was significantly higher in patients who underwent daily pin site care (90.3 vs. 53.3 %, p = 0.001). Of the 144 pin sites, infection occurred at 42 (57.5 %) pin sites in the daily care group and at 19 (26.8 %) pin sites in the non-care group. The number of telephone consultations for postoperative care was significantly higher in the daily care group (1.0 vs. 0.27 call/case, p = 0.007).

Conclusions

Daily pin site care was associated with a higher infection rate and greater stress in postoperative care that required more telephone consultations. The study results could not support daily pin site care. Careful observation of pin sites was recommended in the treatment of pediatric supracondylar humeral fractures.     

The treatment of unstable intertrochanteric fractures of the hip: a prospective trial of 150 cases

We report a prospective clinical trial of 150 cases for the treatment of unstable intertrochanteric fracture of the neck of the femur. Three methods were tested in our series—skeletal traction with a tibial pin, medial displacement osteotomy and valgus osteotomy—with 50 patients in each group. Our results showed no significant difference between those treated with the Dimon and Hughston osteotomy and those treated by the Sarmiento osteotomy. Conservative treatment of skeletal traction for unstable fracture was found to be well tolerated by the Chinese patient. A low mortality and morbidity rate was found in this series with an overall infection rate of 4 per cent.     

罗伊适应模式在腹腔镜下治疗疝患儿临床应用

目的探讨罗伊适应模式（RAM）应用于腹腔镜下疝手术治疗患儿的临床效果。 方法暨南大学附属第一医院自2016年4月至2017年4月收治的60例疝患儿,按照随机数字表法分为对照组和试验组试验组,每组30例。对照组患儿采用腹腔镜下疝修补术治疗的常规护理,试验组患儿在对照组基础上给予RAM进行护理。比较2组患儿的手术时间、下床活动时间、住院时间、并发症的发生情况及家属的护理满意度。 结果试验组患儿的手术治疗时间、下床活动时间、住院时间均显著少于对照组。试验组患儿中发生切口愈合不良1例、出现腹部牵拉痛1例;对照组患儿中发生切口感染2例、切口愈合不良3例、腹部牵拉痛4例、尿潴留3例。试验组患儿的不良反应发生率（6.67%）显著低于对照组（40.00%）,试验组患儿家属的护理总满意度（96.67%）显著高于对照组（70.00%）,差异具有统计学意义（P<0.05）。 结论腹腔镜下疝修补术治疗患儿围手术期采用RAM护理措施,可缩短手术时间、促进早期恢复、减少并发症发生,提高患儿家属的护理满意度。     

Displaced supracondylar humeral fractures in children. A comparison of results and costs in patients treated by skeletal traction versus percutaneous pinning.

Clinical outcome and treatment cost were compared in 65 children treated by either percutaneous pinning or skeletal traction for displaced supracondylar humeral fractures. Clinical outcome was evaluated by loss of elbow motion and change in carrying angle. Results of treatment were basically equivalent in the two groups and were satisfactory in 90% or more. To determine treatment cost, the authors analyzed factors that vary according to the type of therapy. Cost of treatment was lowest in those who had percutaneous pinning and subsequent pin removal in the office. Compared to this group, the cost of treatment increased by 23% in those who had percutaneous pinning and removal of the pins as a surgical procedure, by 117% in those treated by traction with the olecranon pin inserted in the emergency room, and by 142% in those treated by traction with the olecranon pin inserted in the operating room.     

单臂外固定支架配合跟骨牵引治疗胫腓骨粉碎性骨折

目的报告单臂外固定架配合跟骨牵引治疗胫腓骨粉碎性骨折的疗效。方法186例胫腓骨粉碎性骨折,其中开放骨折42例,闭合骨折142例,均采用单臂外固定架,配合跟骨牵引治疗。结果随访185例,183例骨愈合,平均愈合时间6个月,按Johner-Wrichs,优113例,良69例,差2例。针为17.5%。结论单臂外固定支架配合跟骨牵引治疗胫腓骨粉碎性骨折,方法,疗效肯定。     

Osteomyelitis in burn patients requiring skeletal fixation

Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them. In order to determine the safety of skeletal fixation, we reviewed all pediatric patients treated with pin insertion during the past 10 years. Forty-one severely burned children (61+/-3% TBSA full thickness burns), had a total of 357 skeletal fixation procedures. Pins were maintained an average of 25.3+/-1.7 days. Thirteen pins (3. 6%) were loose before the expected time of removal, two patients (4. 8%) presented with cellulitis of the pin site and two patients (4. 8%) presented with osteomyelitis. Loose pins, pin site cellulitis, burn wound infection and sepsis were not associated with osteomyelitis. Skeletal fixation in severely burned patients presents with a low incidence of infectious complications. Its use should be considered in patients affected by severe burns that present with exposed deep structures and for positioning purposes. The exact timing for pin removal in burned patients is still to be defined.     

No role for antiseptics in routine pin site care in Ilizarov fixators: A randomised prospective single blinded control study

Introduction

Pin site infection is the commonest complication of Ilizarov external fixation. The aim of the study was to examine if use of antiseptics was superior over control and further if daily dressing was superior to weekly dressing in regular pin site care in reducing the burden of pin site infection in Ilizarov fixators.

The comparison of exit-site care with normal saline and povidone-iodine in preventing exit-site infection and peritonitis in children on chronic peritoneal dialysis treatment

Peritonitis and catheter exit- site infections (ESI) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis (CPD). The frequency of infection can be reduced by scrupulous exit- site care with or without topical antiseptics. There are no studies showing any benefit in the use of povidone-iodine or normal saline for care of exit- sites in long- term CPD patients. In this study, we aimed to determine the potential effectiveness of the application of povidone-iodine or normal saline at the catheter exit- site in preventing ESI and peritonitis in children on CPD. A total of 98 patients treated with either povidone-iodine or normal saline were included in this study. Group I (34 patients) used povidone-iodine and group II (64 patients) simply cleansed the exit- site with normal saline (0.9% NaCl). Dressings were changed 2 to 3 times in a week. The total cumulative follow- up time was 3233 patient- months. ESIs occurred in 10 (29.4%) of 34 patients using povidone-iodine and in 10 (15.6%) of 64 patients using normal saline. The frequency of ESI was significantly high in group I (povidone-iodine) patients. The mean rate of ESI was 1 episode/60.8 patient- months for group I versus 1 episode/144 patient- months for group II (P < 0.05). The rate of peritonitis was similar in each group (1 episode/21.3 patient- months for group I versus 1 episode/20.17 patient- months for group II) (P > 0.05). In conclusion, exit- site care with normal saline is an effective strategy in reducing the incidence of ESI in children on CPD. It can thus significantly reduce morbidity, catheter loss, and the need to transfer patients on peritoneal dialysis to hemodialysis.     

Pin site care during external fixation in children: results of a nihilistic approach

We prospectively followed 27 consecutive children with tibial circular external fixators applied between July 1, 1995, and June 30, 1997. A simple pin care system with no physical pin cleansing except that provided by daily showers was used. Children with inflamed or infected pin sites were placed on an oral antibiotic (cephalexin) for 10 days. Pin sites were graded according to the system of Dahl et al. on a 0 to 5 scale. A total of 4,473 observations was made. Patients developed 178 pin tract infections (4.0% per observation), with 151 (85%) grade 1 and 27 (15%) grade 2 infections. No pin was removed because of infection. Diaphyseal half pin sites were less commonly infected (1.6%) than periarticular wire or half pin sites (4.5%). We recommend only showering without other physical pin cleaning procedures in children undergoing external fixation procedures.