In recent years, the design and manufacture of artificial joints is further perfect, and the surgical requirements are also improving, especially the application of imported artificial joints, which is more demanding, and it is very important for nurses to cooperate with the doctor to successfully complete the surgery. Now the experience of surgical cooperation is introduced as follows.
Clinical data
This group of 23 cases of male 17 cases, female 6 cases; age 60 to 81 years old, an average of 68.5 years old. There were 14 cases of right hip and 9 cases of left hip. The postoperative efficacy was excellent in 15 cases, good in 5 cases, fair in 2 cases, and poor in 1 case, with an excellent rate of 86.9%.
Surgical cooperation: 1. Preoperative preparation - first of all, to understand the use of domestic or imported artificial joints, with cemented or uncemented; and to understand the installation of the type, size and dimensions. In preparation, three sets of the same type of artificial joints should be prepared for intraoperative selection. In addition to routine and special instruments, 1 meter of steel wire, 2 steel wire pliers, 1 silicone drainage tube, and deep illumination lamp should be prepared before operation. If cemented artificial joints are used, vacuum pumps, cement guns and various types of medullary plugs should be prepared. In addition, taking the lateral position during the operation, it is also necessary to prepare 2 renal supports, 2 round pillows, 1 flat pillow and 1 inflatable air ring to facilitate the fixation of the body position.
2. Intraoperative cooperation - the operation is carried out in accordance with the routine cooperation. Because the surgical wound is large and deep, it is easy to leave behind small items. Therefore, before the completion of the operation and the closure of the wound, the surgical nurse and the roving nurse counted the items together and reported to the doctor after making sure that there was no mistake. Artificial hip replacement surgery has high asepsis requirements, and once infection occurs, the surgery will be a complete failure, bringing great pain and loss to the patient. Therefore, the surgical staff should have a high sense of responsibility, strict implementation of aseptic operation, to avoid all possible factors that may cause infection, in order to facilitate the doctor to quickly, ready and smooth completion of the operation.
DISCUSSION
Total hip arthroplasty is an orthopedic category IV surgery. Patients suitable for this type of surgery are older, have more coexisting conditions, and are at risk. The aim of the surgery is to remove the damaged joint and reinstall the artificial joint. Currently, there are quite a number of types and models of artificial hip joints, so it is important to know what kind of variety the surgeon is using when preparing for the operation. If a domestic artificial joint is used, there is no mold to try on during the operation, and the dimensions obtained by the doctor based on preoperative X-ray measurements are not very accurate. If you only prepare 1 or 2 sets of artificial joints according to the size provided, and if the size is too big or too small during the operation, you will have to prolong the operation time if you re-prepare the joints again. In the author's opinion, according to the size of the prosthesis provided by the surgeon, such as 44 mm in diameter, we should prepare one set of 42, 44 and 46 mm in diameter, so as to facilitate the choice of intraoperative use. The imported artificial joints have molds for trial installation during the operation, plus the use of γ-ray sterilization and spare, so according to the size of the mold can be selected.
During the operation, the patient was placed in the lateral position and required to be fixed firmly. When installing the artificial acetabulum, it is necessary to measure the angle of acetabular placement according to the body position. Therefore, we put an air ring under the axilla of the healthy side of the patient to avoid axillary artery and axillary vein compression. A kidney rest is used on each side of the chest and back, with a long round pillow in the center. A flat pillow was placed between the legs, and the chest and ribs and between the legs were fixed with a medium single tie. This method is good stability, the patient is more comfortable, the doctor's surgical operation is also convenient.
Familiarizing yourself with the special instruments of surgery is an important part of surgical cooperation. The difference between artificial hip arthroplasty and other orthopedic surgeries lies in the complexity of the surgical process and the number of special instruments, which requires the operating room nurses to continuously learn and improve. In this regard, the nurses in the operating room should not only study the relevant information and literature by themselves, but should also often ask the doctors to explain the surgical process, the name of the surgical instruments, their uses and how to use them. Especially imported artificial joints, special instruments are more, must master the application, in order to be able to cooperate in the operation.
The operation of bone cement currently applied is more demanding. Previously, the bone cement used the worker mixing method, a large amount of air enters and produces more air bubbles in the bone cement, which affects the fastness of the bone cement. In contrast, vacuum pump mixing, medullary plug filling, and bone cement gun pumping injection method are currently used. Bone cement mixing is usually operated by nurses, so the operating room nurses are required to practice and master it in normal times.
Two,
Artificial joint replacement asepsis requirements are very high. Because the artificial prosthesis itself is a huge foreign body, once the postoperative infection, the prosthesis must be removed before the infection can be controlled. But after the removal of artificial joints, not only for the patient to bring great pain, but also make the patient become disabled. Therefore, the instruments and materials used must be sterilized and disinfected by high-pressure and chemical methods, and boiling should be avoided. The operating room should be closely sterilized before the operation, and it is important to do a good job of psychological care during the operation.
Artificial hip arthroplasty after surgery improves the patient's quality of life, but also alleviates the family's life care, is a better ideal surgical method.
Three,
Artificial hip arthroplasty instruments are used for hip rheumatism, tuberculosis, tumors and ischemic necrosis of the femoral head and other disorders such as hemiarthroplasty and total joints and the surface of the replacement of the special instruments. The scoliosis correction instrument is a special instrument for correction of scoliosis deformity and fixation of vertebral fracture by pressurization. These two kinds of instruments are the special instruments necessary for modern orthopedic surgery abroad. They are the products popularized and applied in the 70's in foreign countries. In order to improve the level of orthopedic medical technology in China, reduce the doctor's labor intensity, ensure the safety and reliability of the operation, and save foreign exchange, the research of this project was carried out. The two kinds of instruments include surgical instruments and internal fixation instruments respectively. Artificial hip replacement instruments **** including 18 varieties of 37 pieces, of which the key pieces are Yin file, Yang file, femoral head cup, acetabular cup, total hip joint, femoral head cup placer and other complex craftsmanship, processing difficulty of the parts, must have special molds, tire, cutting tools and special equipment to ensure the smooth progress of the processing and dimensional accuracy. Scoliosis correction instruments*** 18 varieties and 99 pieces. The material of the internal fixation instrument of this project has a big breakthrough, and the latest material in China is chosen. Cobalt-bismuth-molybdenum alloy, but the processing is difficult, casting requires special technology, in order to meet the design requirements, improve the processing technology and equipment. The chemical composition, structure and physical properties of this material basically reach the level of international similar materials (HS-21). Appraisal opinion: reasonable design, fine processing, novel structure, strong technology, modeling and structure are suitable for clinical requirements, complete and perfect instruments, sharp edges, durable, easy to operate.