In recent years, the design and manufacture of artificial joints have been further improved, and the surgical requirements have been continuously improved, especially for the application of imported artificial joints. It is very important for nurses to cooperate with doctors to successfully complete the operation. The experience of surgical cooperation is introduced as follows.
clinical data
There are 17 males and 6 females in this group. The age ranged from 60 to 81year, with an average of 68.5 years. Right hip 14 cases, left hip 9 cases. The postoperative curative effect was excellent 15 cases, good in 5 cases, fair in 2 cases and poor 1 case, and the excellent and good rate was 86.9%.
Operational cooperation: 1. Preoperative preparation-first of all, we should know whether the artificial joint is made in China or imported, with or without bone cement; And understand the installed model, size, etc. When preparing, three sets of artificial joints of the same model should be prepared for intraoperative selection. In addition to routine and special instruments, 1m steel wire, two wire cutters, 1 silica gel drainage tube and deep lighting should be prepared before operation. If artificial joints with bone cement are used, vacuum pumps, bone cement guns and various types of intramedullary plugs should be prepared. In addition, two renal supports, two round pillows, 1 flat pillow and 1 inflatable balloon should be prepared for lateral position during the operation, which is convenient for body position fixation.
2. Intraoperative cooperation-routine cooperation during operation. Because the surgical wound is large and deep, it is easy to leave small items. Therefore, before the operation is completed and the wound is closed, the surgical nurse and the visiting nurse will count the items together and report to the doctor after confirming that they are correct. The aseptic requirement of artificial hip replacement is high. Once infected, the operation will be a complete failure, which will bring great pain and loss to the patients. Therefore, the operator should have a high sense of responsibility, strictly carry out aseptic operation, avoid all factors that may cause infection, and help the doctor to complete the operation quickly, prepare and smoothly.
discuss
Total hip replacement is the fourth kind of plastic surgery. The patients who are suitable for this kind of operation are older, have more coexisting diseases and have certain risks. The purpose of the operation is to remove the damaged joint and reinstall the artificial joint. At present, there are many kinds and models of artificial hip joints, so it is very important to know which kind of artificial hip joint doctors use when preparing before operation. If the domestic artificial joint is used, there is no mold during the operation, and the size measured by the doctor according to the preoperative X-ray film is not very accurate. If only 1 ~ 2 groups of artificial joints are prepared according to the provided size, the operation time will be prolonged if it is too large or too small. The author thinks that according to the prosthesis size provided by the doctor, if the diameter is required to be 44 mm, we will prepare a set of 42 mm, 44 mm and 46 mm respectively, which is convenient for intraoperative selection. However, imported artificial joint surgery has mold trial assembly and γ -ray disinfection for standby, so it can be selected according to the size of the mold.
Taking the lateral position during the operation requires firm fixation. When installing artificial acetabulum, the angle of acetabulum placement should be measured according to the posture. Therefore, we put an air bag under the healthy side of the patient to avoid compressing the axillary artery and vein. Kidney support for chest and back, long round pillow in the middle. Put a flat pillow between your legs and tie it between your chest rib and your legs with a tie. This method is stable, comfortable for patients and convenient for doctors to operate.
Familiarity with special instruments is an important part of surgical cooperation. The difference between artificial hip replacement and other orthopedic operations is that the operation process is complicated and there are many special instruments, which need the nurses in the operating room to learn and improve constantly. In this regard, operating room nurses should not only learn relevant literature by themselves, but also often ask doctors to explain the operation process, the names, uses and usage of surgical instruments. In particular, there are many imported special instruments for artificial joints, which must be skillfully applied in order to be handy in surgical cooperation.
At present, the operation requirements of bone cement are high. In the past, cement was mixed by workers, and a large amount of air entered, resulting in more bubbles in cement, which affected the fastness of cement. At present, vacuum pump stirring, medullary cavity embolization and bone cement gun pumping are used. Cement mixing is generally operated by nurses, so nurses in the operating room are required to practice and master it at ordinary times.
Second,
The aseptic requirement of artificial joint replacement is very high. Because the artificial prosthesis itself is a huge foreign body, once infection occurs after operation, the prosthesis must be taken out to control the infection. However, after the artificial joint is taken out, it not only brings great pain to the patient, but also makes the patient disabled. Therefore, the instruments and materials used must be sterilized by high pressure and chemical methods, and boiling disinfection is prohibited. The operating room should be strictly disinfected before operation, and it is very important to do psychological nursing during operation.
Artificial hip replacement improves the quality of life of patients and reduces the life care of family members, which is a better and ideal surgical method.
Third,
Artificial hip replacement device is a special instrument for semi-joint, total joint and surface replacement of hip rheumatism, tuberculosis, tumor and avascular necrosis of femoral head. Scoliosis orthosis is a special instrument for correcting scoliosis deformity and spinal fracture by compression reduction and fixation. These two instruments are necessary special instruments for modern orthopedic surgery abroad. It was widely used abroad in 1970s. In order to improve the level of orthopedic medical technology in China, reduce the labor intensity of doctors, ensure the safety and reliability of surgery and save foreign exchange, the research of this project was carried out. These two instruments include surgical instruments and internal fixation instruments respectively. Artificial hip replacement instruments * * * include 37 pieces of 18, among which the key parts are female files, male files, femoral head cups, acetabular cups, total hip joints, femoral head cup placers and other parts with complicated technology and difficult processing. Special molds, fixtures, cutters and special equipment must be provided to ensure smooth machining and dimensional accuracy. There are 99 kinds of scoliosis correction instruments *** 18. A great breakthrough has been made in the material of the fixing device in this project, and the latest domestic materials have been selected? Cobalt-bismuth-molybdenum alloy, but it is difficult to process and requires special technology for casting. In order to meet the design requirements, the processing technology and equipment were improved. The chemical composition, structure and physical properties of this material have basically reached the level of (HS-2 1) international similar materials. Appraisal opinion: reasonable design, fine processing, novel structure, strong technology, shape and structure suitable for clinical requirements, complete equipment, sharp cutting edge, durability and convenient operation.