术中获得性压力性损伤预防专家共识

目的 形成《术中获得性压力性损伤预防专家共识》,为预防手术患者术中获得性压力性损伤提供实践指导。 方法 通过文献检索,提取术中压力性损伤预防相关的证据和专家推荐意见,形成初稿,通过2轮专家咨询和4次线上会议进行修改和完善。 结果 术中获得性压力性损伤预防专家共识内容包括术中获得性压力性损伤风险因素与护理评估、评估工具选择、评估时机选择、风险界定与分级、分级预防措施和管理6个方面。 结论 该共识基于证据与指南,通过循证方法构建,操作性、实用性强,可为手术患者术中获得性压力性损伤预防和手术室护理管理提供理论依据和实践指导。     

PDCA循环方法在术中压力性损伤管理应用的探讨

目的 探讨PDCA循环管理方法在降低手术室压力性损伤发生的价值。方法 于2018年1至12月将PDCA循环管理方法用于手术室压力性损伤的管理,对2017年1月至12月在我院手术中发生的77例术中压力性损伤进行调查分析、制定相应的整改措施并实施,比较开展PDCA活动前后术中压力性损伤发生率。结果 开展PDCA活动后,术中压力性损伤发生率由活动前的0.284%降至活动后0.113%,改善幅度达到151%。结论 应用PDCA循环管理方法可显著降低术中压力性损伤发生率,进一步保障患者安全。     

神经外科术中获得性压力性损伤的预防护理专案

目的 降低神经外科术中获得性压力性损伤发生率。 方法 将2019年10～12月的1 378例神经外科择期手术患者作为对照组,采取常规护理措施预防术中获得性压力性损伤。将2020年10～12月的1 551例患者作为观察组,成立护理专案小组,开展多学科协作,实施护理专案改善。 结果 观察组术中获得性压力性损伤发生率为0.90%,对照组为2.18%,两组比较,差异有统计学意义（P＜0.05）;两组术中获得性压力性损伤治愈率比较,差异无统计学意义（P＞0.05）。观察组预防术中获得性压力性损伤关键监测指标落实率较好,除术后规范交接班落实875例（61.40%）外,其他指标均＞88.00%。 结论 多学科协作护理专案能够有效降低术中获得性压力性损伤发生率,提高术中获得性压力性损伤预防和管理质量。     

不同美容护理干预预防COVID-19防疫医护人员鼻面部压力性损伤效果观察

目的:探讨不同美容护理干预在新型冠状病毒肺炎疫情期间预防医护人员鼻面部压力性损伤的效果。方法:将2020年1月-2020年3月笔者医院隔离病房的80例接受护理干预的医护人员随机分为对照组(40例)和观察组(40例),对照组采用水胶体敷料护理干预,观察组采用超薄泡沫敷料护理干预,比较两组医护人员鼻面部压力性损伤的发生情况及满意度。结果:观察组鼻面部压力性损伤发生率为7.5%(3/40)低于对照组的25.0%(10/40),且观察组医护人员对敷料舒适性满意度评分显著高于对照组,差异均具有统计学意义(P<0.05)。结论:在预防医护人员鼻面部压力性损伤的发生中,超薄泡沫敷料效果优于水胶体敷料,且舒适度更高。     

心血管手术患者术中压力性损伤的研究进展

分析心血管手术患者术中压力性损伤发生原因及相关因素,对常用压力性损伤风险评估工具进行评价,常用的评估工具包括Waterlow量表、Braden量表和Norton量表及针对手术患者开发的压力性损伤风险评估工具。提出应重视对此类患者术中压力性损伤相关因素的有效识别,进一步探讨心血管手术特异性的相关因素以及不同类型患者相关因素的差异性,为制定有针对性的预防措施提供参考。     

髋关节镜的临床应用现状

在骨科领域，目前越来越多地使用关节镜技术来诊断和治疗各种关节疾病。迄今为止，关节镜手术最常用于膝关节，其次是肩关节和踝关节，而髋关节疾病的关节镜诊治还处于起步阶段。通过髋关节镜可显示出髋臼盂唇、股骨头、髋臼软骨表面、髋臼圆韧带及邻近的滑膜囊，使40％其他手段无法确诊的髋关节痛得以明确诊断，但髋关节镜不仅有较高的技术需求，还需有专业的配套器械。本文对髋关节镜的临床应用现状综述如下。     

术中压力性损伤与受压部位微环境关系的研究

目的探究受压部位微环境与俯卧位手术患者发生术中压力性损伤的关系,为临床实施预防措施提供参考。方法选取择期手术患者99例,获取患者人口学及手术相关资料,以及受压部位皮肤温度和皮肤湿度情况。结果俯卧位手术患者术中压力性损伤发生率为10.10%,多发生在手术结束后24 h内,颧骨及髂前上棘为好发部位。皮肤温度、核心温度升高是俯卧位手术患者压力性损伤的危险因素(OR值为8.215、7.186,均P<0.05)。结论受压部位微环境对俯卧位手术患者术中压力性损伤有影响,应采取针对性干预措施,降低术中压力性损伤发生率。     

液体石蜡油涂抹预防腰椎后路手术病人压力性损伤的效果

目的 探讨液体石蜡油在预防腰椎后路手术病人俯卧位皮肤压力性损伤中的效果。方法 选取2017年1月至2019年3月在我院行腰椎后路手术的病人300例,采用随机数字表法分为常规组、石蜡油组和液体敷料组,每组各100例。常规组采取常规俯卧位护理措施;石蜡油组在常规俯卧位护理的基础上,将液体石蜡油均匀涂抹于病人的前额、颧弓、下颌、锁骨、双前胸、髂骨、大腿根部至膝关节等受压部位;液体敷料组在上述涂抹部位采用液体敷料进行干预。记录三组病人术后皮肤受压情况,采用美国国家压力性损伤顾问小组（National Pressure Ulcer Advisory Panel, NPUAP）压力性损伤分期（2016年版）评估压力性损伤分期,比较三组病人的压力性损伤发生率。结果 术后石蜡油组和液体敷料组各有2例发生Ⅰ期压力性损伤,发生率均为2%。常规组有10例发生压力性损伤（Ⅰ期压力性损伤8例,Ⅱ期压力性损伤2例）,发生率为10%。石蜡油组和液体敷料组病人的压力性损伤发生率均显著低于常规组,组间比较差异有统计学意义（F=9.590,P＜0.05）。结论 液体石蜡油可以有效预防腰椎后路手术病人俯卧位皮肤压力性损伤的发生,是一种简单、安全、有效的方法,值得推荐。     

髋关节镜下治疗髋臼股骨撞击症合并盂唇损伤的疗效分析

目的 探讨髋关节镜下治疗髋臼股骨撞击症（femoroacetabular impingement, FAI）合并盂唇损伤的临床疗效。方法 回顾性分析2016年2月至2020年5月厦门市海沧医院采用髋关节镜下治疗FAI合并盂唇损伤的34例病人的临床资料。收集并比较术前及术后末次随访的髋关节屈曲、内收、屈髋90°内旋活动度,疼痛视觉模拟量表（visual analogue scale, VAS）评分,改良Harris髋关节功能评分。结果 所有病人伤口均甲级愈合,术后2例会阴部麻木,1例患足麻木,1周后症状消失;1例股外侧皮神经损伤后大腿前外侧麻木,经过营养神经治疗1个月后恢复正常;随访（18.0±5.8）个月（12~36个月）,32例病人（94.1%）对手术效果表示满意;病人术后末次随访的髋关节屈曲、内收和屈曲90°内旋角度、VAS评分及改良Harris髋关节功能评分与术前比较,差异均有统计学意义（P均＜0.05）。所有病人均无伤口感染、血管损伤、异位骨化、股骨颈骨折、坐骨神经损伤、股神经损伤、髋关节不稳定或髋关节脱位等严重并发症发生。随访期间,未见髋关节骨关节炎进展,无需二次行髋关节镜下翻修手术。结论 在严格把握手术指征、加强并发症防范意识,努力提高手术技术的前提下,髋关节镜下治疗FAI合并盂唇损伤,能够有效缓解病人症状,改善髋关节活动功能,是一种安全、微创、疗效确切的手术方法。     

Diagnostic arthroscopy of the hip joint

Objective  Refinement of diagnosis of hip disorders with the possibility of adding minimally invasive surgical procedures. Indications  Hip symptoms and effusions not yet diagnosed. Disorders where a decision has to be taken whether to continue conservative care or to proceed with surgery. Intraarticular loose bodies. Labral lesions. Biopsies to establish a diagnosis. Synovial diseases. Localized articular cartilage defects. Purulent arthritis. Contraindications  Recent fracture of acetabulum. Advanced osteoarthritis. Impossibility to distract the joint. Surgical Technique  Supine. Arthrography for imaging of labrum and femoral head. Joint distension. 3-portal technique for arthroscopy of the central compartment of the joint under traction on a fracture table. 2-portal technique for viewing of the peripheral compartment without traction. Both techniques make use of 30° and 70° arthroscopes. Results  Between October 1997 and end of 2000, we performed 60 hip arthroscopies: 34 of the central and peripheral compartments, 16 of only the central and ten of only the peripheral compartment. Besides synovial reactions in all, 15 of 33 hips with early or moderate osteoarthritis showed additional intraarticular lesions. These findings justified an early total hip replacement in six patients. In four out of six patients with unclear hip symptoms, a final diagnosis could be established. In another five patients the diagnosis could be confirmed (4× chondromatosis, and 1× free body). In five patients indication for correctional osteotomy was validated and in one rejected due to advanced articular cartilage damage. Complications: transient hypoesthesia (4×), superficial cartilage damage (7×), instrument breakage (2×), small labral tears (4×), soft tissue edema and early termination of operation (2×).     

Diagnostic arthroscopy of the hip joint in pigmented villonodular synovitis

A case of pigmented villonodular synovitis of the hip is presented. The delay between the onset of symptoms and the histopathologic confirmation of this condition generally accounts for the massive local bone invasion, frequently necessitating a total hip arthroplasty. Earlier diagnosis through arthroscopy and subsequent chemical synoviorthesis might reduce the need for more aggressive surgery and improve the prognosis of this rare condition.     

Hip arthroscopy without traction: In vivo anatomy of the peripheral hip joint cavity

Purpose: To describe the in vivo anatomy of the peripheral compartment of the hip joint using a systematic sequence of examination without traction. Type of Study: Case series. Methods: We performed 35 hip arthroscopies without traction from an anterolateral portal in the supine position. Free draping and a good range of movement of the hip joint were used to relax parts of the capsule and increase the intra-articular volume of the area that was inspected. Each procedure was documented on a standard protocol including detailed information on technical features and normal and pathologic intra-articular findings. Results: A comprehensive inspection of the peripheral compartment was obtained from the anterolateral portal. A systematic sequence of examination was developed separating the periphery of the hip joint into 7 areas: anterior neck area, medial neck area, medial head area, anterior head area, lateral head area, lateral neck area, and posterior area. The arthroscopic in vivo anatomy of each area is described. In 3 patients, 1 to 3 loose bodies were removed. In 1 patient with a synovial chondromatosis, 40 chondromas were retrieved. In osteoarthritis, impinging osteophytes were trimmed in 3 cases and partial synovectomy was performed in 10 patients. The following complications were observed: a temporary sensory deficit of the lateral femoral cutaneus nerve in 1 patient, scuffing of the anterior surface of the femoral head in 3 patients, detaching of an osteophyte in 1 patient, and partial tears of the anterior synovial fold in 10 patients. Conclusions: Arthroscopy without traction allows for a complete evaluation of hip anatomy without the loaded articular surfaces, the acetabular fossa, and the ligamentum teres. For a complete overview of both the central and peripheral part of the hip, traction is necessary for the central part.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 924–931     

环节质量控制护理预防高龄髋部骨折患者压疮

目的对预防高龄髋部骨折患者压疮的护理环节的质量监控及控制,以降低高龄髋部骨折患者压疮发生率。 方法选取中山大学附属第一医院关节外科2018年09月至2020年07月入院的高龄髋部骨折患者108例,按照随机数字法分为对照组和实验组,对照组54例,实施常规压疮护理,实验组54例,实施环节质量控制的护理模式。观察比较两组患者对压疮预防相关健康宣教知识的掌握程度、护理满意度评分及压疮发生率,评估环节质量控制的风险评估/判断准确率、护理干预有效率、护理相关记录合格率及风险管理合格率的改变情况,组间比较采用t检验或卡方检验。 结果患者对压疮预防相关健康宣教知识的掌握程度评估,对照组为(79±13)分,实验组为(89±10)分(t＝-4.585,P<0.001)。护理满意度评分：对照组为(80±15)%,实验组为(89±10)%(t＝-3.449,P<0.01);实验组患者无压疮发生,明显低于对照组11%的发病率(χ²＝4.412,P <0.05)。 结论加强对高龄髋部骨折患者压疮预防的重点环节干预,可提高环节质量,降低发生压疮的危险因素,有效预防压疮发生。     

Postoperative creatine kinase elevation following hip arthroscopy and associated risk factors

ObjectiveThe aim of this study was to investigate postoperative CK and risk factors for CK elevation after hip arthroscopy.MethodsThis retrospective study reviewed 122 patients (50 males, 72 females; mean age, 44.1 years) who underwent hip arthroscopy from September 2012 to March 2018. For all patients, CK was investigated preoperatively, on postoperative days 1 and 3, and at postoperative weeks 1 and 2. Univariate and multivariate analysis was performed for parameters including sex, age, body mass index, preoperative glomerular filtration rate, diagnosis, duration of surgery, and duration of traction to determine the risk factors for CK > 10 upper limit of normal (CK > 10 ULN; 1900 IU/L for males and 1500 IU/L for females) after surgery.ResultsMean CK was 104.7 ± 68.7 IU/L preoperatively and 839.2 ± 2214.0, 523.9 ± 1449.4, 186.0 ± 690.7, and 122.0 ± 307.1 IU/L on postoperative days 1 and 3 and at postoperative weeks 1 and 2, respectively. CK was significantly higher on postoperative days 1 and 3 than before surgery. In total, 11 patients (9.0%), including 8 males (16.0%) and 3 females (4.2%), had CK > 10 ULN. Younger age and longer duration of traction are independent risk factors for CK > 10 ULN.ConclusionAfter hip arthroscopy, CK levels should be monitored, especially in young patients and cases of prolonged duration of traction during surgery.Level of evidenceLevel IV, therapeutic study.     

关节镜与MRI诊断膝关节韧带损伤的对照研究

目的对比关节镜与MRI检查膝关节韧带损伤的精准率,评价临床应用效果。方法选取膝关节韧带损伤患者52例,进行关节镜及手术前先采用MRI诊断技术进行检查,检查后的7d~6个月内进行关节镜检查或手术,将两次诊断的结果进行对比。结果 MRI诊断与关节镜及手术损伤程度的符合率:前交叉韧带为93.5%,后交叉韧带为100%,外侧副韧带为90.6%,内侧副韧带为88.5%,关节镜及手术对比诊断的符合率为93.1%。结论膝关节韧带损伤的诊断检查采用MRI诊断技术,具有精准率高、无创、安全、方便等优势,临床应用效果满意。     

Hip arthroscopy in the presence of dysplasia

Purpose: Intra-articular pathology of the hip is often associated with dysplasia. The presence of dysplasia is often believed to be a harbinger of poor results for arthroscopy. The purpose of this study was to report the results of operative hip arthroscopy in conjunction with dysplastic disease of the hip. Type of Study: Prospective clinical case series. Methods: All patients undergoing hip arthroscopy are prospectively assessed with a modified Harris hip score performed preoperatively and postoperatively at 3, 12, 24, and 60 months. A minimum of 1-year follow-up has currently accumulated for 184 consecutive cases. The center edge (CE) angle of Wiberg is measured on the anteroposterior pelvis film and categorized as normal (> 25°), dysplastic (< 20°), or borderline dysplasia (20°-25°). Results: In this study, 48 patients were identified with either dysplasia (16) or borderline dysplasia (32). At an average of 27 months, 100% follow-up was noted. For the dysplastic group, the average preoperative score was 57 and postoperative score was 83. For borderline dysplasia, the average preoperative score was 50 and postoperative score was 77. Statistically, no difference was found between the 2 groups. Collectively, the average improvement was 27 points, with 79% (38 patients) of patients showing at least a 10-point improvement. Conclusions: The results of arthroscopy in the presence of dysplasia compare favorably with the general population previously reported. The response to treatment is probably dictated more by the nature of the intra-articular pathology rather than simply the presence or absence of radiographic evidence of dysplasia.     

股骨髋臼撞击综合征患者髋关节镜术后并发髋关节炎的危险因素分析

目的:探讨股骨髋臼撞击(femoro-acetabular impingement,FAI)综合征患者髋关节镜术后并发髋关节炎(hip osteoarthritis,HOA)的危险因素,减少和预防HOA的发生。方法:自2018年9月至2020年9月采用髋关节镜手术治疗106例FAI患者,男40例,女66例;年龄20～55(33.05±10.19)岁;运动伤51例,交通事故伤36例,钝物砸伤19例;病程5～19(12.02±3.69) d。术后随访18个月,根据是否发生HOA将患者分为HOA组23例和无HOA组83例。采用多元Logistic回归分析影响FAI患者髋关节镜术后并发HOA的危险因素。结果:经单因素分析,HOA组年龄50～70岁、女性、身体质量指数>30 kg·m^-2、体力劳动、凸轮型、术后并发感染、术后末次随访髋关节关节活动度(range of motion,ROM)及T?nnis分级1级及以上比例均高于无HOA组(P<0.05),相对骨骼肌指数(relative appendicular skeletal muscle index,RAS...     

髋关节镜的治疗进展

髋关节是人体重要的负重关节,周围有坚强的肌肉保护以及丰富的神经结构,这使得对其病变的诊断及治疗相对困难。常规手术往往会严重损害周围软组织及重要结构,术后出现关节粘连等并发症的可能性较大。随着关节镜器械及技术的发展,髋关节镜的应用近20年得到了迅速发展,其具有切口小,对周围组织神经损伤轻等优点。关节镜对髋关节病变的诊断起到了重要作用,同时还提供了更好的治疗方式。随着设备与技术的改进,MRI在髋关节疾病诊断的广泛应用,关节镜微创治疗逐渐成为髋关节疾病的临床技术之一。