患儿人工假体钛肋脊柱矫形手术的护理

Perioperative nursing care of pediatric spinal correction surgery with application of artificial prosthetic titanium rib

目的：人工假体钛肋（VEPTR）是一种新型植入设备,用于椎体畸形或缺陷患者加强其脊柱的稳定。患儿VEPTR手术对护理工作有许多新的要求。文内探讨手术护理对患儿VEPTR脊柱矫形手术效果的影响。方法：对我院自2006年至2008年中因脊柱侧凸行VEPTR脊柱矫形手术28例患儿的护理工作进行总结。其中男性18例,女性10例;年龄2~7岁。特发性脊柱侧凸13例,先天性脊柱侧凸9例,神经源性脊柱侧凸2例,神经纤维瘤病性脊柱侧凸3例,Chari畸形伴脊柱侧凸1例。术前Cobb角58°~89°,平均74°。对其术前准备,术中配合及术后护理的特殊要求加以详尽记录,对手术情况和手术结果与护理工作的关系进行分析。结果：手术后Cobb角为30°~41°,平均36°,矫正率为52%。28例手术进行均较顺利,平均时间2.5 h,术中出血100~300 ml。术后未发生与手术相关的并发症,患儿术后恢复良好。结论：仔细的术前访视及器械物品准备,良好的术中配合和积极的术后护理是减少术后并发症、保证手术效果良好的重要条件。

Objective： The vertical expandable prosthetic titanium rib VEPTR is a new implant for the treatment of congenital scoliosis to enhance the stability of the spine. To investigate the efforts of perioperative nursing care on the surgical outcomes of pediatric spinal correction surgery with application of artificial prosthetic titanium rib. Methods ：28 children with scoliosis undergoing spinal correction surgery by artificial prosthetic titanium rib from 2006 to 2008 were included. There were 18 males and 10 females, with an age from 2 to 7 years. There were 13 patients with idiopathic scoliosis,9 patients with congenital scoliosis,2 patients with neurogenic scoliosis ,3 patients with scoliosis in nerofibermatosis and 1 scoliotic patient with Chari malformation. The average preoperative Cobb angle was 74°（range 58°and 59°）. The preoperative preparation, operative cooperative and postoperative care were recorded, and the relationship between surgical outcomes and nursing care was analysed. Results：The postoperative Cobb angle were 36°（range 31° -40°）. The corrective rate was 54%. All the surgery were performed successfully. The mean operative time was 2.5h and the intra- operative blood loss ranged from 100ml to 300ml. No operation-related complication was observed. Conclusion： careful preoperative observation and instruments preparation, good operative cooperation and active postoperative nursing are important factors for satisfae-tory surgical outcomes.