系统化三防三位护理措施在预防不同疾病行人工髋关节置换术患者假体脱位中的应用效果

Effects of the systematic ＆quot;three preventions and three positions＆quot; nursing on preventing arthritic prosthesis dislocation after total hip arthroplasty

目的 探讨三防三位护理措施对预防不同疾病行人工髋关节置换术患者假体脱位的效果.方法 本研究采用历史对照的方法,选取2012年1月—2013年12月某院骨科收治的459例人工髋关节置换术患者为对照组,采用传统护理方法,按骨科护理常规给予宣教和指导及围术期护理.2014年1月—2016年12月收治的768例人工髋关节置换术患者为试验组,在常规护理的基础上,应用系统化“三防三位”护理对患者提供针对性的整体护理.比较两组患者术后3个月内假体脱位发生率的差异.结果 试验组假体脱位总发生率为0.65%,其中髋关节翻修术、股骨颈骨折、股骨头坏死、先天性髋关节疾病患者脱位发生率分别为1.56%、0.90%、0.64%、0.52%.对照组假体脱位总发生率为2.18%,其中髋关节翻修术、股骨颈骨折、股骨头坏死、先天性髋关节疾病患者脱位发生率分别为33.33%、1.25%、0.70%、0.70%.试验组总假体脱位发生率低于对照组（χ2=5.552,P〈;0.05）,试验组髋关节翻修术患者假体脱位发生率低于对照组（χ2=5.485,P〈;0.05）;试验组股骨颈骨折、股骨头坏死、先天性髋关节疾病患者假体脱位发生率低于对照组,但差异无统计学意义（χ2值分别为0.309、0.743、2.771;P〉0.05）.结论 系统化＆quot;三防三位＆quot;护理措施可有效降低人工髋关节置换术后假体总脱位率及髋关节翻修术患者假体脱位发生率,值得推广.

Objective To explore the effects of the systematic ＂three preventions and three positions＂ nursing on preventing arthritic prosthesis dislocation after total hip arthroplasty （THA） for different diseases. Methods Based on historical control, 459 patients who received THA in the orthopedics department of a hospital between January 2012 and December 2013 were selected as a control group. Patients in the control group received conventional nursing as well as health education and perioperative care as per routines. Totally 768 patients who received THA in the same hospital between January 2014 and December 2016 were selected as a treatment group. On the basis of conventional nursing, patients in the treatment group received targeted holistie nursing derived from the systematic ＂three preventions and three positions＂ nursing. The incidence of arthritic prosthesis dislocation between the two groups 3 months after THA was then compared. Results The incidence of arthritic prosthesis dislocation of the treatment group was 0.65%, including 1.56% for revision of THA, 0.90% for femoral neck fractures, 0.64% for osteonecrosis of the femoral head （ONFH）, and 0.70% for congenital hip disorder （CHD） patients, while the incidence of arthritic prosthesis dislocation of the control＂ group was 2.18%, which included 33.33% for revision of THA, 1.25% for femoral neck fractures, 0.70% for ONFH, and 0.70% for CHD patients. The treatment group＇s incidence of arthritic prosthesis dislocation was lower than that of the control group （ X^ 2=5.552; P 〈 0.05） ： The incidence of arthritic prosthesis dislocation of THA revision patients in the treatment group was significantly lower than that of the patients in the control group （ X^ 2=5-485 ;P 〈 0.05）; and the incidence of arthritic prosthesis dislocation among femoral neck fractures, ONFH and CHD patients in the treatment group was lower than the patients in the control group （ X^ 2=0.309, 0.743, 2.771 ; P 〉 0.05）. Conclusions The systematic ＂three preventions and three positions＂ nursing helps to reduce the incidence of arthritic prosthesis dislocation after THA and THA revision, which is worthy of application and expansion.