序贯康复护理在髂骨瓣移植治疗保髋患者中的应用

Application of sequential rehabilitation nursing in patients with hip preservation treated with iliac bone flap transplantation

目的探索带血管蒂髂骨瓣移植术治疗股骨头坏死患者术后实施序贯康复护理的效果。方法选取2019年1月至2020年12月解放军联勤保障部队第九二〇医院骨科收治的39例股骨头坏死行带血管蒂髂骨瓣移植治疗患者为观察组,给予序贯康复护理;以2017年1月至2018年12月收治的36例股骨头坏死行带血管蒂髂骨瓣移植治疗患者为对照组,术后给予常规护理。采用t检验和卡方检验比较两组患者VAS疼痛评分、下肢深静脉血栓(DVT)发生率、髋关节Harris评分。结果75例均获随访,随访时间平均(15±5)个月,随访期间观察组患者股骨头坏死未进一步加重。术后末次随访Harris评分(t=5.642,P<0.001)及优良率(χ^(2)=6.445,P<0.05)观察组均高于对照组。术后24、72 h和7 d的VAS评分观察组均低于对照组(t=4.178,8.805,13.002,均为P<0.05)。DVT发生率观察组更低(χ^(2)=5.271,P<0.05)。结论序贯康复护理有助于提高带血管蒂髂骨瓣移植术治疗股骨头坏死患者痛阈,减轻患肢疼痛,降低术后DVT发生率,促进髋关节功能恢复。

Objective To explore the effect of sequential rehabilitation nursing after vascularized iliac bone flap transplantation for patients with femoral head necrosis.MethodsFrom January 2019 to December 2020,39 patients with osteonecrosis of the femoral head who were treated with vascularized iliac bone flap transplantation in the department of orthopedics of 920 Hospital of the Joint Logistic Support Force of the PLA were selected as the observation group and given sequential rehabilitation nursing.From January 2017 to December 2018,36 patients with osteonecrosis of femoral head treated with vascularized iliac bone flap transplantation were selected as the control group,and routine nursing was given after the operation.Visual analogue scale(VAS),incidence of lower extremity deep vein thrombosis(DVT),and Harris hip score were compared between the two groups byttest andchi squaretest.ResultsAll the 75 patients were followed up for(15±5)months.During the follow-up,there was no further aggravation of femoral head necrosis in the observation group.At the last follow-up,Harris score(t=5.642,P<0.001)and excellent hip rate(χ^(2)=6.445,P<0.05)showed better results in the observation group than the control group.The VAS scores at 24,72 h and seven days after the operation in the observation group were lower than that in the control group(t=4.178,8.805,13.002,allP<0.05).The incidence of DVT was also lower in the observation group than the control group(χ^(2)=5.271,P<0.05).ConclusionSequential rehabilitation nursing can improve the pain threshold of patients with femoral head necrosis treated by vascularized iliac bone flap transplantation,reduce the pain of affected limb,reduce the incidence of DVT after operation,and promote the recovery of hip function.