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Received:January 10, 2023 Published Online:September 19, 2023
Received:January 10, 2023 Published Online:September 19, 2023
中文摘要: 目的 总结骨科机器人辅助吻合血管腓骨移植治疗股骨头缺血坏死(ANFH)患者的护理经验。方法 2016年9月至2020年11月北京积水潭医院手外科采用骨科机器人辅助吻合血管腓骨移植的方法治疗ANFH患者17例(21髋),术后给予扩血管、抗凝、抗感染治疗及相关护理,并进行功能康复指导。结果 21髋手术顺利。所有患者均无供区神经损伤、术后下肢静脉血栓形成等并发症。术后3个月内免负重,3~6个月之间拄拐部分负重。10例患者(12髋)术后随访1年以上,平均15个月(12~24个月)。9例患者髋关节功能恢复顺利,有1例患者为双侧ANFH,右侧恢复顺利,左侧髋关节活动受限,疼痛,后经关节镜探查,关节内无感染和腓骨头穿出等问题,处理髋臼侧骨赘后,症状缓解。结论 对机器人辅助吻合血管腓骨移植治疗ANFH,护理应重点关注供区是否有神经损伤,术后护理需要以移植的腓骨成活为目的,术后功能锻炼也是重要部分。
Abstract:Objective To summarize the nursing experience of osteopathic robot-assisted vascularized fibular transplantation in the treatment of patients with avascular necrosis of femoral head (ANFH). Methods From September 2016 to November 2020, there were 17 ANFH patients (21 hips) in Beijing Jishuitan Hospital undergoing vascularized fibular graft assisted by orthopedic robots. After operation, the patients were given vasodilator, anticoagulant, anti-infective and related nursing care, as well as functional rehabilitation guidance. Results The operation was successful in 21 hips. All patients had no complications such as donor nerve injury and postoperative lower limb venous thrombosis. There was no weight-bearing activity within 3 months postoperatively and partial weight-bearing on crutches between 3 and 6 months. Among 10 patients (12 hips) followed for an average of 15 months, the hip function recovered well in 9 patients, and one bilateral ANFH patient, in whom the right side recovered smoothly, but the left hip joint was painful and restricted. No intra-articular infection and fibular head protrusion were found by arthroscopic exploration in this patient, and the symptoms were relieved after treatment of acetabular osteophyte. Conclusion For the treatment of ANFH with robot-assisted vascularized transplantation, nursing should focus on whether there is nerve injury in the donor area and on postoperative survival of the transplanted fibula. Postoperative functional exercise is an important part of the recovery for limb function.
keywords: Avascular necrosis of femoral head Orthopedic robot Fibula transplantation Vascular anastomosis Nerve injury Baking lamp Pressure ulcers Deep vein thrombosis
文章编号: 中图分类号:R473.6 文献标志码:B
基金项目:首都临床特色应用研究(Z171100001017132)
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