系统综合护理在四肢骨折患者中的应用

目的:探讨系统综合护理在四肢骨折患者中的应用方法及临床效果。方法:将120例四肢骨折患者随机分为观察组与对照组各60例。对照组给予四肢骨折常规护理,观察组在对照组基础上给予系统综合护理;观察比较两组并发症发生情况、废用性肌肉萎缩、舒适度情况、住院时间及患者满意度。结果:两组在并发症、废用性肌肉萎缩、舒适度及住院时间、患者满意度等方面比较,差异有统计学意义(P<0.05)。结论:加强系统综合护理可以提高患者舒适度及满意度,降低并发症发生率,缩短住院时间,有效促进四肢骨折患者尽早恢复,值得推广。     

Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?

Aims and objectives. The aims were to investigate whether there were any differences between patients receiving nutritional intervention preoperatively and over five days postoperatively and patients who did not, in terms of postoperative complications, rehabilitation, length of stay and food and liquid intake. Background. Patients with hip fractures are often malnourished at admission to hospital and they typically do not receive the energy and calories needed postoperatively. Design. The design was a quasi‐experimental, pre‐ and post‐test comparison group design without random group assignment. Methods. One hundred patients with hip fractures were consecutively included. The control group (n = 50) received regular nutritional support. The intervention group (n = 50) received nutrition according to nutritional guidelines. The outcome measures used were risk of pressure ulcer, pressure ulcers, weight, nosocomial infections, cognitive ability, walking assistance and functional ability, collected preoperatively and five days postoperatively. Each patient’s nutrient and liquid intake were assessed daily for five days postoperatively. Results. Significantly fewer (p = 0·043) patients in the intervention group (18%) had pressure ulcers five days postoperatively compared with the control group (36%). Nutrient and liquid intake was significantly higher (p < 0·001) in the intervention group. Median length of stay decreased from nine to seven days (p = 0·137), as did nosocomial infections, from 18–8·7% (p = 0·137). Conclusion. Patients with hip fractures receiving nutrition according to nutritional guidelines developed fewer pressure ulcers. This is invaluable to patients’ quality of life and a major economic saving for society. Relevance to clinical practice. Great benefits can be gained for the patients through modest efforts by nurses and physicians such as nutritional intervention.     

锁定型颈椎前路钢板系统治疗胸骨骨折

胸骨骨折常合并有胸腹部严重并发症和其它部位骨折,病情凶险,如诊治不当,可引起严重后果[1]。2006年5月～2011年9月,我们采用锁定型颈椎前路钢板系统治疗9例严重胸骨骨折患者,取得了较好效果,报道如下1材料与方法     

绵羊胫骨火器伤段性骨缺损模型建立

目的建立绵羊胫骨火器伤段性骨缺损动物模型。方法绵羊6只,7.7式手枪枪击胫骨中段制成火器贯通伤骨折后用钢板内固定,再制成胫骨中段25.0 mm长骨缺损。术后第4、8、12、16周分别拍X线片观察胫骨缺损区成骨情况。16周全部处死动物,取缺损区标本进行组织学评价。结果所有动物骨缺损处X线片Lane评分均为0分,组织学观察显示无骨组织长入。结论绵羊胫骨25.0 mm缺损模型不能自主成骨,符合火器伤段性骨缺损模型要求。     

微型钛板内固定在下颌骨骨折患者中的应用及效果

目的探讨微型钛板内固定在下颌骨骨折患者中的应用及效果。方法选择本院2005年6月～2012年6月收治的下颌骨骨折患者54例为研究对象,采用微型钛板内固定,比较患者术后1、3、6个月创口愈后情况、术后感染情况和咬合功能恢复情况。结果患者术后1、3个月和6个月时,咬合功能恢复正常者分别为8、40例和52例。术后1个月出现感染的患者3例,3个月后无再次感染发生,6个月后所有患者伤口基本处于Ⅰ期愈合。结论采用微型钛板内固定治疗下颌骨骨折临床疗效明确,术后患者咬合功能恢复完全。     

股骨近端解剖型钢板治疗股骨转子间骨折

目的探讨股骨近端解剖型钢板治疗股骨转子间骨折的临床价值。方法回顾分析38例股骨转子间骨折应用股骨近端解剖型钢板手术治疗临床资料,根据术前术后X线片及术后髋关节功能、站立及行走等恢复情况评价内固定效果。结果38例随访时间6个月至2年,根据黄公怡评定标准,优23例,良12例,差3例。结论股骨近端解剖型钢板是治疗股骨转子间骨折的一个很好的方法。     

Subtrochanteric fractures of the femur. Treatment with locking intramedullary nailing. An experience without C-Arc. The guide-wire stopping method for verify distal locking is described

ObjectiveEvaluate the results of treatment of subtrochanteric fracture with interlocked intramedullary nail and describe a technical for accurate and secure verification of distal locking position when we do surgery without arc-C.MethodsA case series where was reviewed the results in 49 patients with subtrochanteric fracture and treated locking intramedullary nailing. The AO and Russell–Taylor Classification were used. The statistic procedure was done with SPSS program. The traumatic hip scale of Sander et al. was used for final evaluation. Technical for doing distal locking is detailed.ResultsThis series evaluated 49 patients: 35 male and 14 female patients. The mean age was 36 years old (range: 18–86 years). Traffic accidents and gunshot wounds were injury forms most frequent. There were not transoperative complications. The surgical time was between 90 and 120 min (mean: 108 min). The mean follow-up was 24 months (range: 18–36 months). According to Sanders score, it was reported 22 excellent results, 20 good results and 7 regular results. All distal locking procedures were successfully performed.ConclusionAlthough this series consists in a few numbers of patients, we recommend the placement of interlocked intramedullary nail (Closs-MB Bioimpianti^® and Orthosintese^®) in subtrochanteric fractures. This device allows placement of distal locking through the insertion frame with safety and precision, even in surgery rooms without arc-C. The guide-wire stopping method allows the verification of distal locking in an objective, accurate, safe and reproducible way.