综合技术分期手术再造跟骨治疗跟骨感染性骨缺损的护理体会

Nursing experience of calcaneus reconstruction by comprehensive technique and staged operation in the treatment of calcaneal infectious bone defect

目的探讨采用综合技术分期手术治疗跟骨感染性骨缺损的全疗程和全方位护理效果。方法回顾性分析2017年1月至2021年1月在解放军总医院第四医学中心骨科医学部接受综合技术分期手术治疗的10例跟骨感染性骨缺损患者的病例资料,其中男6例,女4例,平均年龄(37.0±11.1)岁。术前利用3D打印模型对患者实施个体化健康教育,一期手术采用腓肠神经营养皮瓣覆盖创面、骨水泥填塞骨缺损,术后通过皮瓣护理措施观察血运情况并预防血管并发症;二期手术采用综合技术(3D打印个体化钛笼及Masquelet技术自体肋骨植骨)重建跟骨缺损,护理措施包括术前心理护理、取肋骨处护理和重建跟骨术后的护理。术后12个月随访时采用Maryland足功能评分和美国矫形外科足踝协会(American Orthopaedic Foot and Ankle Association,AOFAS)踝-后足评分评价足部功能。结果所有患者均获得随访,随访时间12~30个月,平均(18.2±5.9)个月。一期手术后8例愈合良好,2例发生深部感染,再次清创更换骨水泥后愈合。二期手术临床愈合时间为(4.3±1.6)个月。术后12个月Maryland足功能评分为(92.0±4.2)分,AOFAS踝-后足评分为(89.8±6.1)分。所有患者术后均未发生局部感染、钛笼松动、螺钉断裂、骨质吸收、内固定移位等全身或局部并发症。结论术前应用3D打印个体化钛笼模型对患者进行直观、个体化的健康教育及心理护理,术后对取皮瓣、取骨区和跟骨区进行个体化护理,可保障手术治疗效果。全疗程、全方位护理有助于提高感染性跟骨骨缺损重建的成功率,减少围术期并发症。

Objective To investigate the entire course of treatment and comprehensive nursing effect of treating calcaneal infectious defects with 3D printing individualized titanium cages and Masquelet technology.Method A retrospective analysis was performed on 10 calcaneal infectious bone defect cases treated by staged surgery and comprehensive techniques.There were 6 males and 4 females;they were 37 years old.The first-stage sural neurotrophic skin flap covers the wound and bone cement fills the bone defect.The skin flap is used for nursing measures to observe blood supply and prevent vascular complications.The second-stage reconstruction of the calcaneus pre-care includes 3D printing models to implement individualized health education for the patient and the second-stage preoperative psychological care.The postoperative care measures for reconstructing the calcaneus with rib grafting and titanium mesh include observation and reconstruction of the calcaneus-nursing measures after thoracic surgery behind ribs.The Maryland score and the American Society of Foot and Ankle Surgery(AOFAS)ankle-hindfoot score were used to evaluate foot function during the follow-up.Result All were followed up for 18.2 months(12-30 months).8 cases healed well after the primary operation,2 cases of deep infection,and healed after debridement and replacement of bone cement.In the second phase,autogenous rib bone grafting using Masquelet technology and 3D printed individualized titanium mesh implantation were used to reconstruct the shape and structure of the calcaneus.The clinical healing time was 4.32 months;the Maryland score was 92 points and the AOFAS score was 89.8 points after 12 months.The full range of care in the whole course of treatment helps improve the infectious heel.The success rate of bone defect reconstruction reduces the perioperative complication rate.Conclusion Preoperative application of 3D printed individualized titanium cage model for intuitive and individualized health education and psychological care for patients,skin flap,bone removal area and calcaneus area after an operation can ensure the effect of surgical treatment.