肱骨远端骨不连围手术期的护理

目的:探索肱骨远端骨缺损与骨不连的显微外科修复后的护理方法。方法:采用解剖钢板固定为支架,取吻合血管的腓骨置入式移植方法,修复肱骨远端骨缺损与骨不连12例。术前加强心理护理与营养调理,术后着重进行患肢伤口周围、受区与供区的护理、出院前功能锻炼的指导等。结果:经围手术期的护理与术后功能锻炼的指导,无并发症发生,经3月～24个月随访,移植腓骨全部成活,退行变的肘关节面骨质恢复正常,肘关节仲屈,前臂旋转功能获得恢复,肢体的短缩获得纠正,持重也获得令人满意的效果。结论:本组邻近肘关节的肱骨远端骨不连均行外科手术2次～5次,硬化的骨质已累及肘关节的冠状窝,采用一般的吻合血管腓骨移植,无法获得固定,也可能进一步累及关节功能,而在解剖钢板固定支持下,吻合血管腓骨移植段可在相对稳定环境下获得愈合;该法护理简便,痛苦少,病程短,病人易于接受。

Nursing on Patients under Microsurgical Repair of Refractory Defect and Non-union in Distal Humerus

To probe the nursing methods for patients who have received microsurgical repair of refractory defect and non-union in distal humerus. Methods: We attended 12 cases of refractory defect and non-union in distal humerus repaired by microsurgical grafting of free fib with blood vessel with the support of anatomical bone plate. To be more specific, the patients were specially given preoperative psychological nursing and nutritional nursing, and the nursing was stressed on anesthesia, cut areas, grafted areas and free-fib supplying areas, as well as the instruction on functional exercises after their leaving hospital etc. Result: With such nursing and instruction, no complications occurred. The follow-up survey from 3 to 24 months shows that all the grafted free fibs with blood vessels were in bony union, the result of which was the normal osteosis of recessive elbow joint, the recovery of bend and stretch function of elbow joint and the recovery of turning function of antebrachium, in addition , the limbs were recovered to the normal length and a satisfactory loading result was attained. Conclusion: Averagely, the operation should be performed 2-5 times for this distal humeral non-union by elbow joint. Since indurated sclerotin has implicated processus coronoideus, common microsurgical grafting of free fib with blood vessel could not attain the expected fixation, which could further implicate the function of elbow joint, while by adopting support of anatomical bone plate, grafted free fib with blood vessel could be well in bony union under relative stable condition. This method might be easy for nursing, and the patients are willing to accept it for its advantages of less pain and short course of disease.