体位管理在老年股骨近端防旋髓内钉内固定手术患者中的效果观察

Observation on the effect of position management in elderly patients undergoingproximal femoral anti rotation intramedullary nail fixation surgery

目的 探讨体位管理在老年股骨近端防旋髓内钉内固定手术中的应用效果。方法 选择2020年10月-2022年10月我院收治的行股骨近端防旋髓内钉内固定手术患者97例,按随机数字表法分为2组,对照组为48例,观察组为49例。对照组手术体位行仰卧单腿截石位,观察组手术体位行仰卧“剪刀”位。比较2组患者围术期相关指标、骨折愈合时间、骨折复位质量、术后髋关节功能恢复及并发症发生情况。结果 (1)观察组患者手术时间、术中出血量、术中透视次数均少于对照组(P<0.05),切口长度、住院时间与对照组比较差异均无统计学意义(P>0.05)。(2)观察组患者骨折愈合时间、骨折复位质量总优良率与对照组比较,差异均无统计学意义(P>0.05)。(3)2组患者术后3个月、6个月时髋关节功能恢复各项评分及总分组内比较差异均有统计学意义(P<0.05),组间比较差异均无统计学意义(P>0.05)。(4)观察组患者术后总并发症发生率低于对照组(P<0.05)。结论 股骨近端防旋髓内钉内固定手术中应用仰卧“剪刀”体位并结合护理人员针对性的术前情绪管理、深呼吸训练、咳嗽训练、卧床排便,术中体位摆放,术后功能锻炼可缩短患者手术时间,减少术中出血量及术中透视次数,降低并发症发生率,值得临床推广。

Objective To explore the effect of position management in proximal femoral anti rotation intramedullary nail fixation surgery.Method A total of 97 patients who underwent proximal femoral anti rotation intramedullary nail fixation surgery in our hospital from October 2020 to October 2022 were selected and randomly divided into 2 groups by using a random number table method,a control group of 48 cases and an observation group of 49 cases.The control group was placed in a supine one leg lithotomy position during surgery,while the observation group was placed in a supine"scissors"position during surgery.Compare perioperative related indicators,fracture healing time,fracture reduction quality,postoperative hip joint function recovery,and incidence of complications between 2 groups of patients.Results(1)The surgical times,intraoperative bleeding,and intraoperative fluoroscopy times in the observation group were less than those in the control group(P<0.05),and there was no statistically significant difference in incision length and hospital stay between the observation group and the control group(P>0.05).(2)There was no statistically significant difference(P>0.05)in the fracture healing time and overall excellent rate of fracture reduction quality between the observation group and the control group.(3)There were statistically significant differences in hip joint function recovery scores and intra group comparisons between 2 groups at 3 and 6 months after surgery(P<0.05),while there was no statistically significant difference between groups(P>0.05).(4)The overall incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion The use of supine"scissors"position combined with targeted preoperative emotional management,deep breathing training,cough training,bed rest and defecation,intraoperative position placement,and postoperative functional exercise in proximal femoral anti rotation intramedullary nail fixation surgery can shorten the patient's surgical time,reduce intraoperative bleeding and intraoperative fluoroscopy frequency,and reduce the incidence of complications.It is worthy of clinical promotion.