微创膝关节及髋关节置换术后患者疼痛分析

目的探讨微创人工膝、髋关节患者手术后疼痛及疼痛不良反应的差异。方法采纵贯式研究设计方式,以该院骨科150例接受人工膝、髋关节置换术患者为研究对象,分为全人工膝关节置换术(TKR)及全人工髋关节置换术(THR)两组。以结构式问卷、疼痛评估纪录包括疼痛影响项目及视觉模拟评分量表(VAS),收集术后3 d疼痛评估资料并进行分析。结果术后疼痛程度及疼痛不良反应发生率均随时间增加而降低(P0.05);TKR组患者手术后疼痛程度高于THR组患者;MIS(微创)术式患者疼痛程度虽于术后24 h高于传统术式,但术后48和72 h疼痛程度已明显低于传统术式,MIS(微创)术式患者术后疼痛程度较低。两组患者疼痛的最主要不良反应均为不敢翻身,THR组术后疼痛不敢翻身发生率高于TKR组(t=15.62,P=0.000)。结论 VAS评分能够用于THR和TKR术后患者疼痛评价,其评价结果能够协助干预THR和TKR术后患者疼痛。     

The influence of total hip replacement on the quality of life of patients suffering from coxarthrosis

Introduction. The main purpose of this study was to determine the influence of surgical procedures (total hip replacement) concerning patients suffering from coxarthrosis on the quality of life of these patients. The quality of life was analysed before as well as after the arthroplasty.
Material and methods. The study was conducted by means of the Medical Qutcome Study 36- item Short Form (SF-36). The following parameters were used to evaluate the quality of life: physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problem, mental health, energy/viataliity, body pain, general health perception. The Questionnaire was completed by patients from the Department of Orthopedics and Traumatology, Medical Academy and Orthopedyand Traumatology Ward in Wojewódzki Szpital im. Dr J. Biziela in Bydgoszcz, suffering from coxarthrosis The results were compared with the control group.
Results. The study revealed that quality of life of the surveyed is considerably lower in comparison with the control group in all domains apart from general health perception. The most significant differences were seen in terms of bodily pain, physical functioning and role limitations due to physical problems. Slightly less important differences were observed in vitality, mental health, social functioning and role limitations due to emotional problems. As a results of surgical treatment (total hip replacement), the quality of life self-assessment considerably increased in terms of lessening of bodily pain, physical functioning improvement and vitality.
Conclusions. The following conclusions have been drawn: quality of life concerning patients suffering from coxarthrosis is significantly lower in comparison with the control group. The surgical treatment caused improvement in functioning but quality of life in particular components was considerably lower than in the control group.     

The experiences of patients undergoing total hip replacement

This qualitative study describes the experiences of total hip replacement (THR) patients before hospitalization, in hospital and following discharge. Eight men and nine women (mean age 66 years) described their experiences of being a patient, care received and of the health care organization. The participants were recovering from THR and were interviewed twice: first four days after operation and then 8–12 weeks later.Data interpretation was based on the method of content analysis. Experiences of being a THR patient included physical, psychological and social aspects. One of the main physical experiences was pain. Psychological experiences were the different kind of resources the patients had. Social experiences were changes in social roles and in social life. Experiences of care referred to how different professionals acted and how the patients were treated as individuals. Experiences of the organization before and after hospitalization were associated with external and internal services.Pain management should be further improved and patients' own resources should be taken into closer consideration when planning the care.     

全髋关节置换围术期应用塞来昔布超前镇痛的疗效评估

目的观察塞来昔布对于髋关节置换的超前镇痛作用,及其减少其他镇痛药物用量和不良反应的效果。方法 40例股骨头坏死行髋关节置换患者,随机分为观察组(手术禁食前首次给药400 mg,手术后6 h再次给药200 mg,术后2 d,塞来昔布200 mg,2次/d);对照组(术前不给药)。两组均于术后麻醉药物作用消失后使用硬膜外镇痛(PCEA),维持手术后48 h。分别于入院时,麻醉前、术后0 h、2 h、4 h6、h、12 h、24 h、48 h进行可视痛觉评分(VAS),记录镇痛药物用量、不良反应。结果实验组患者围术期VAS评分低于对照组(P<0.05),围术期其他镇痛药物用量及药物不良反应明显低于对照组(P<0.05)。结论围术期使用塞来昔布能有解全髋关节置换手术后疼痛,明显减少术后镇痛泵及阿片类药物的使用量,且副作用较小,对于术后髋关节早期活动及功能锻炼有非常积极的意义,因而一定程度上提高了髋关节置换患者术后功能恢复。     

护理干预在人工髋关节置换术中的应用效果观察

目的 实施护理干预对人工髋关节置换术后患者的影响.方法 将102例人工髋关节置换术后患者按住院号单、双号分为干预组与对照组各51例.对照组给予常规护理,干预组在常规护理基础上采用护理干预,观察两组平均住院天数、住院费用、并发症以及两组患者对护理质量满意度,对疾病相相关知识掌握情况.结果 干预组住院天数平均13 d,住院费用平均14000元左右,并发症发生率1.96%,对护理质量满意度98%,对疾病相关知识掌握100%;对照组住院天数平均18 d,住院费用平均17 000元左右,并发症发生率19.59%,对护理质量满意度85%,对疾病相关知识掌握80%,两组比较差异有显著临床意义(P＜0.01).结论 干预组缩短了住院天数,降低了医疗费用,降低了并发症的发生率,提高了对护理质量满意度,以及提高了对疾病相关知识掌握程度.     

超前镇痛对全髋置换患者的应激反应及术后疼痛的影响

目的:观察超前硬膜外镇痛用于全髋置换患者的临床效果及对血中儿茶酚胺的影响。方法:选择40例拟行全髋置换的患者,随机分为超前镇痛组和对照组,每组20例。术前12h开始镇痛,实验组硬膜外导管输入0.2%罗哌卡因5ml/h;对照组输注0.9%的生理盐水。采用硬膜外麻醉,术毕开始硬膜外PCEA+PCA,药物为0.2%罗哌卡因5mg/h。记录局麻药用量、PCA的按压次数。采用100mm视觉模拟积分法,记录放置硬膜外管前、到手术室后、术毕、术后1、2、3、6、9、12、24h的VAS评分。用高效液相色谱法测定血浆去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(D)。结果:超前组和对照组在术后的罗哌卡因用量分别为288.13±38.20mg,384.67±67.44mg,差异有显著性意义(P<0.01)。对照组的PCA按压次数和杜冷丁的应用明显多于超前镇痛组。两组患者NE、E、DA在术毕显著高于术前(P<0.01),术后24h超前组NE、E显著低于对照组。两组均没有发生明显的局麻药毒副作用。结论:超前硬膜外镇痛用于全髋置换患者效果良好,且能有效抑制术后疼痛所致的应激反应。超前镇痛的时间选择应当引起关注。     

同侧髋、膝关节同时置换术后康复

目的:探讨同侧髋膝关节同时置换术的康复方法。方法:对1992年—1999年间收治的30例43侧严重风湿病下肢同侧髋膝关节同时置换术患者进行术后康复治疗,针对这些严重的风湿病患者制订一系列康复措施,并针对同侧髋膝关节同时置换术后的病例特点进行康复。结果:术前术后对比,髋关节术后总活动度平均提高93.7°,髋关节Harris评分较术前提高45分。膝关节活动度平均较术前提高44°,HSS平均较术前提高46.5分。全部患者经过平均5.2年的随访。随访期内,1例1膝患者复发屈膝挛缩,1例1膝出院后家庭康复时不慎摔倒致左股骨干骨折,经手术治疗后骨折愈合。其余患者均对患肢功能主观评价满意,术后疼痛症状明显缓解,出院时所有患者的不扶拐行走距离均超过100m。结论:同侧髋膝关节同时置换术患者的康复应在术前详细制订康复计划,针对病人不同情况采取不同的康复措施,严格遵守循序渐进、因人而异、随时调整的原则。     

Health-related quality of life and health service use following total hip replacement surgery

AIMS OF THE STUDY: The study investigated health-related quality of life in relation to demographic and clinical factors, and health service use and satisfaction by older total hip replacement (THR) patients following discharge from one Australian Hospital. RATIONALE: Understanding health-related quality of life and patterns of service use during recovery informs caregiving and patient and family education needs for discharge planning and case management. BACKGROUND: Post-discharge, older THR patients have a high rate of health services use. Few valid measures of outcomes link nursing discharge or case management to patient-identified health status or service needs. RESEARCH METHODS: Ward nurses conducted telephone interviews to study self-perceived health-related quality of life using Medical Outcomes Study Short-Form (SF-36) and responses to an accompanying questionnaire on demographics, service use and satisfaction at 1, 2, 4, 8, and 12 weeks postdischarge. SF-36 scores were compared with Australian population norms according to age and gender to determine the relative extent of postdischarge recovery. RESULTS: Psychosocial recovery preceded physical recovery, which steadily improved. Physical component summary scores reached population norms and mental component summary scores exceeded norms by week 1. No differences in quality of life were found by age, but women took longer to recover physically. Those who lived alone did not have lower scores than those with residential support. General practitioners were seen most often; nursing visits were frequent only in weeks 1 and 2, specialist visits occurred at weeks 8 and 12. Allied health, hospital and pathology services were used less often. Most patients were satisfied or very satisfied with all services used. DISCUSSION/CONCLUSIONS: An almost immediate impact on quality of life was evident, probably indicating successful pain alleviation. Service use indicated adequate discharge planning and successful recovery. Having ward nurses as researchers was instrumental to continuity of communication between patients, families and service providers, which suggests increased potential for continuity of care.     

Investigation of anterior knee pain after total hip replacement: a pilot study

Background and Purpose. There is no previous research to determine if total hip replacement can lead to anterior knee pain. The idea for the present study came from clinical observation of anterior knee pain (AKP) after total hip replacement, and the objective was to investigate anterior knee pain after total hip replacement. Method. The study used a prospective single‐system design with a convenience sample. Six men and seven women were assessed before and at six weeks after total hip replacement for the presence and degree of AKP, using a step‐down test combined with a visual analogue scale (VAS). Measurements were also taken of leg length, hip and knee motion, thigh circumference and hamstring length using previously validated tests. Results. Eight of thirteen subjects had AKP at six weeks post‐operation. Active knee flexion was reduced post‐operation (p < 0.0007), and proximal, mid‐ and distal thigh circumferences were increased (p < 0.0001). Eleven of 13 subjects demonstrated leg lengthening (p < 0.0001), and 10/11 subjects demonstrated a reduction in passive knee flexion (p < 0.002). All biomechanical data were correlated against the VAS. Although none were statistically significant, both decreased active and passive knee flexion, and increased thigh circumference exhibited the greatest trend with the VAS. Conclusions. The results of the present study cannot be compared to other studies, as there are no previous studies on AKP after total hip replacement. Current outcome measures for total hip replacement do not measure for AKP, although it may potentially hinder full functional recovery. Orthopaedic surgeons and physiotherapists need to be aware if this is a possible complication of total hip replacement, and hence further research is required to test external validity. Copyright © 2006 John Wiley & Sons, Ltd.     

The use of analgesics in patients with acute abdominal pain

Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. One patient was withdrawn secondary to inadequate documentation. Of the 48 patients who completed the trial, a statistically significant change in physical examination was noted in both groups receiving analgesics, but not in the placebo group. No adverse events or delays in diagnosis were attributed to the administration of analgesics. We conclude that physical examination does change after the administration of analgesics in patients with acute abdominal pain and that a larger study is needed to evaluate analgesic safety in this subpopulation of emergency department patients.     

改进型髋关节挡板在全髋关节置换术中的应用

目的:探讨改进型髋关节挡板在全髋关节置换术中的应用。方法:预实验时,模拟髋关节手术体位摆放,观察改进型髋关节挡板与传统体位摆放方法的组装时间、固定后前、后倾角度被动丢失角度、操作人员满意度4个项目;临床验证时将56例全髋关节置换术患者随机分成两组,分别记录两组术前体位摆放所用时间、术中需要再次调整体位的次数、患者术中舒适度。结果:预实验和临床验证中两种体位摆放方法效果的差异具有统计学意义(P<0.01)。结论:改进型髋关节挡板较传统体位摆放方法更适用于全髋关节置换术患者,可进行推广。     

人工髋关节置换术的围手术期护理

目的：提高人工髋关节置换术治疗的效果,有效减少并发症的发生及发展,提高患者的生活质量。方法：回顾性分析总结2004年6月～2008年12月我科收治的21例老年股骨颈骨折患者进行人工髋关节置换的护理经验,包括术前心理护理、术前检查和准备、术后患肢护理及功能锻炼。结果：术后出现深静脉血栓形成2例,给予抗凝治疗,未发生肺栓塞,康复出院;2例合并糖尿病患者发生切口感染,予以抗感染、切口换药,康复出院;3例术后出现谵妄,给予抗精神药物治疗后康复出院。结论：采用人工髋关节置换术治疗股骨颈骨折,通过合理的术前、术后护理及对患者及时认真的观察,给予及时有效的处理后,术后恢复快,显著提高了患者的生活质量。     

Complications of total hip replacement.

The most common complications of total hip replacement are infection, loosening, dislocation, phlebothrombosis and embolism, neurovascular deficity, periarticular calcification, nonunion of the greater trochanter, malposition of components, fractures, and discrepancy in leg length. The cause, prevention, and treatment of these complications are reviewed.     

人工全髋关节置换术的护理进展

人工全髋关节置换术已广泛用于临床,作者从病例选择、人工全髋关节的生物材料及骨水泥的运用以及术后一般护理、疼痛护理、引流管的护理、术后体位及功能锻炼、并发症的预防及护理方面进行了系统的总结。