目的设计制造一种考虑假体尺寸的全膝关节置换术截骨导板(简称截骨导板),实现术中快速、精准定位、辅助截骨的目的。方法截骨导板采用德国EOS公司的FORMIGA P 110三维(3D)打印设备制造,打印材料为聚十二内酰胺(PA12)。通过CT、股骨3D重...目的设计制造一种考虑假体尺寸的全膝关节置换术截骨导板(简称截骨导板),实现术中快速、精准定位、辅助截骨的目的。方法截骨导板采用德国EOS公司的FORMIGA P 110三维(3D)打印设备制造,打印材料为聚十二内酰胺(PA12)。通过CT、股骨3D重建、假体逆向重建获得股骨远端与假体的数字模型,用计算机手术预演确定合理尺寸的假体,固定股骨远端与假体的接触面作为截骨平面,以该平面为基准逐步装配其他部件。3D打印设备模型输入格式为病理性股骨标准模板库(STL),采用选择性激光烧结(SLS)技术生产截骨导板,打印主体材料为聚十二内酰胺(PA12)。制造成品灭菌消毒后,于2019年至2021年用于3例因严重骨关节炎实施的截骨手术,其中男性2例,女性1例;患处位于左侧1例,右侧2例;年龄54~67岁,平均年龄59岁。术中医生严格按照截骨导板使用指南实施截骨手术。统计术中和术后失血量、手术时间、髋膝踝角、胫股角、美国膝关节协会评分(AKS)与美国特种外科医院(HSS)膝关节功能评分对手术结果进行评估。结果成功打印制造截骨导板,主要尺寸:固定钉钉孔到截骨平面的垂直距离10.17~12.51 mm,前髁固定钉钉孔直径3.18 mm;截骨槽宽度1.42 mm,固定钉中心点距离45.44 mm,固定钉钉孔直径3.16 mm。临床试用表明,在截骨手术中使用截骨导板定位股骨远端面,切面呈规则“8”字形状,无明显过切或少切现象,能保证截骨的准确性。未发生摆锯与截骨导板干涉或截骨导板破裂等需要中断手术的事件。术后患者膝关节功能恢复良好,随访过程中未出现假体松动、下沉、膝内外翻畸形、移位、股骨端骨折、脂肪栓塞等不良反应。结论实验研究设计制造的截骨导板能够准确定位,相较于普通截骨工具具有无需开髓、一次安装、多次定位的功能。基于3D打印技术的手术预演有利于医生术前根据患者骨形确定假体规格,提前熟悉截骨参数,预估手术难度,考虑术中可能出现的各种问题,从而制订适合患者的个体化、最优化手术方案。展开更多
BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing method...BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.展开更多
文摘BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.
