颈后路手术治疗类风湿性寰枢椎不稳患者的护理

Perioperative Nursing of Posterior Surgical Approach for Operation of Atlantoaxial Instability Due to Rheumatoid Arthritis

目的 探讨颈后路植骨融合、内固定治疗类风湿性寰枢椎不稳围手术期护理措施。方法 对2 1例类风湿性寰枢椎不稳患者采用颈后路植骨融合、内固定治疗。术前进行心理护理、体位训练、呼吸功能锻炼 ;术后实施体位护理、脊髓神经功能的观察、脑脊液漏的护理、功能锻炼及出院指导。结果 经 6个月～ 2 8个月 (平均 18个月 )随访 ,2 1例患者均获得稳定骨性融合 ,无手术和护理并发症发生。 19例患者神经功能获不同程度改善 ,2例虽无改善但无神经损害发展。结论 颈后路植骨融合、内固定治疗类风湿性寰枢椎不稳手术复杂、风险大 ,实施科学周密的围手术期护理是提高手术效果。

Objective To investigate the peroperative nursing core of surgical treatment of atlantoaxial instability in rheumatoid arthritis through posterior approach. Method Twenty one patients with atlantoaxial instability due to rheumatoid arthritis were treated by fusion and fixation through pasterior approach.Psychological nursing, posture training and respiratory function training were carried cat before operation. After operation,changes of neurological function were clasely watched, posture training, functional training of extremities were practised, cerebrospinal fluid leakage was undercare and guidance was given during discharge. Result With a mean follow up period of 18 months (6 months to 28 months),satisfactory stabilization of the atlantoaxial joint was achieved in all patients without any complication. Neurological recovery was observed in 19 patients,except 2 patients with remnant minor neurologic deficit. Conclusion Operation of atlantoaxial instability due to rheumatoid atthritis through posterior approach is a complex procedure with some hazards. Scientific and comprehensive perioperative nursing care can play an important role in the prevention and reduction of postoperative complications.