联合手术治疗累及附件胸腰椎转移性肿瘤13例围术期护理

Perioperative nursing care in the treatment of 13 patients with metastatic tumors affecting thoracic and lumbar vertebra through posterior debridement of tumors combined with bone cement injection into residual centrum and internal fixation

目的：探讨后路肿瘤病灶清除联合残存病椎体内骨水泥注射及内固定术治疗累及附件胸腰椎转移性肿瘤患者围术期的护理方法。方法：对13例累及附件的胸腰椎转移性肿瘤患者行联合手术，并施行精心护理，包括术前评估、心理护理、营养支持、术后病情观察、引流管护理、皮肤护理、疼痛护理、功能训练及出院指导。结果：本组均未发生护理并发症，随访10～18个月，通过x线、CT或NRI观察，证实内固定牢固。日常生活活动（ADL）能力改善率达100％，术后疼痛完全缓解5例，部分缓解8例。结论：后路肿瘤病灶清除联合残存病椎体内骨水泥注射及内固定术是治疗累及附件转移性脊柱肿瘤较好的手术方法，建立有效的护理康复流程是巩固疗效及预防并发症的关键。

Objective： To explore the perioperative nursing methods in the treatment of metastatic tumors affecting thoracic and lumbar vertebra through posterior debridement of tumors combined with bone cement injection into residual centrum and internal fixation. Method： Careful nursing care was given to 13 patients who received operation, including preoper- ative assessment, psychological care, nutritional support, postoperative condition observation, drainage tube care, skin care, pain relieving, functional training and instruction on the discharged patients. Results： No complications due to nurs- ing care occurred. Following up for 10 - 18 months, the X -ray, CT or MRI observations confirmed the strong fixation. The improvement rate was 100% in activities of daily living （ADL}, postoperative pain completely alleviated in 5 patients, partial alleviated in 8 patients. Conclusion ： Posterior debridement of tumors combined with bone cement injection into resid- ual centrum and internal fixation is a preferable therapy in the treatment of metastatic tumors affecting thoracic and lumbar vertebra and establishment of an effective rehabilitation process of nursing care is very important in consolidating the curative effect and preventing complications.