前侧微创入路微创全髋置换手术的手术配合

DAMIS cooperation of minimally invasive total hip arthroplasty

目的探讨前侧微创入路DAMLS全髋置换术的手术配合及经验。方法选取2013年8月~2015年9月我院74例行DAMIS全髋置换手术的临床资料及手术配合进行总结,总结配合及手术护理要点。常规对患者摄双侧髋关节及骨盆的X线,通过比较术前、术后的Harris髋关节评分评估手术疗效,手术护士要提前准备手术所需髋关节假体、物品、器械,熟悉手术步骤;术中注意无菌操作,仔细清点器械、缝针、纱布等小物件防止遗留体内。保持患者体温、皮肤的保护、体位的护理、麻醉的配合,严密观察生命体征,积极主动快速安全配合手术。结果 76例手术中,平均切口长度为(9.5±1.5)cm、手术时间为(132.7±11.7)min、术中出血量为(219.4±104.6)ml、住院天数为(7.8±1.9)d,所有患者未发现股外侧皮神经损伤症状、术中骨折、深部感染、脱位等并发症。手术中护理配合安全顺利,无护理不良事件发生。结论采用DAMIS全髋关节置换术,软组织保护好、术中出血少,有利于患者髋关节功能的快速恢复,但是手术技术要求相对较高,学习曲线长。充分的术前准备,娴熟的手术配合及术前、术后细致的护理,均是确保患者的安全、手术成功关键因素。

Objective To discuss the nursing cooperation and experience in the DAMLS（direct anterior minimum invasive surgery） minimally invasive total hip replacement surgery.Methods Based on the regression analysis of the clinical data of 74 cases DAMIS routine total hip replacement surgeries from August 2013 to September 2015 in our hospital,the research summarizes the nursing cooperation and surgical care points.Through doing routine X-ray examination of patients′ bilateral hip and pelvis to compare the preoperative and postoperative Harris hip scores to assess the efficacy of the surgeries,surgical nurses should prepare the required hip prosthesis,goods,equipment in advance,familiarize with the surgical procedures,in the surgery pay attention to aseptic surgery,and make careful inventory of equipment,needles,gauze and other small objects to prevent left over in the patients′ body after the surgery.Nurses should monitor the patient′ s temperature,protect the skin,do the postural care,give patient anesthesia,and observe the patient′ s vital signs closely to offer active,quick and safe cooperation in the surgery.Results In the 76 cases of surgery, the average length of the incision was（9.5±1.5） cm,the operative time was（132.7±11.7） min,the blood loss was（219.4±104.6）ml,the number of days in hospital was（7.8±1.9）d,and none of the cases had following complications,lateral femoral cutaneous nerve injury symptoms,intraoperative fracture,deep infection,dislocation and so on.In the surgery,nursing was done safely and smoothly,and no care adverse events happened.Conclusion The DAMIS total hip replacement surgery protect the soft tissue well,and ensure less blood loss,which helps the patients recover the hip function rapidly,but the requirements of the surgical technique are relatively high,and the techniques need long-time learning.Adequate preparation before the surgery,skilled surgery cooperation and meticulous care before and after the surgery are key factors in ensuring the safety of the patients,the success of the surgery.