目的 探讨"天玑"骨科机器人辅助手术治疗腕舟骨骨折的临床疗效,为腕舟骨骨折的机器人辅助治疗提供参考依据.方法 回顾性分析2021 年6 月至2022 年6 月北京积水潭医院手外科收治的56 例腕舟骨骨折患者,其中经骨科机器人辅助手术治疗 24 例为试验组,传统徒手操作手术治疗的 32例为对照组.通过比较两组患者在平均住院时间、手术时长、术中出血量、术中透视次数、腕关节功能评分(Mayo评分)等指标差异,分析"天玑"骨科机器人系统辅助手术治疗腕舟骨骨折的临床疗效.结果 试验组的平均住院时间和对照组相比未见显著性差异[(4.92±2.15)d vs.(4.72±1.87)d,t=0.368,P=0.714].试验组的手术时长显著短于对照组[(60.29±9.96)min vs.(89.72±15.04)min,t =-8.309,P＜0.001],术中出血量显著少于对照组[[(4.50±1.62)mL vs.(9.56±3.20)mL,t=-7.087,P＜0.001],术中X线透视次数显著少于对照组[2(1,3)次 vs.9.5(8,12)次,Z=-6.392,P＜0.001].腕关节功能方面,术后 6 个月随访时,试验组患者的 Mayo 评分显著高于对照组[(95.83±2.82)分 vs.(89.72±4.71)分,t=5.642,P＜0.001].结论 骨科机器人辅助手术治疗腕舟骨骨折和传统徒手操作手术相比,其手术时长更短、术中出血量更少、术中透视次数更少,且术后腕关节功能更优.

Objective:To explore the application of interactive communication mode combined with problem-based learning in clinical teaching of undergraduate nursing students so as to provide basis for nursing teaching reform.Methods:A total of 62 undergraduate nursing students in Beijing Jishuitan Hospital were selected. Among them, 32 cases from September to November 2018 received traditional teaching (the control group), and 30 cases from September to November 2019 were given interactive communication mode combined with problem-based learning (the observation group). The assessment results, comprehensive ability, clinical communication ability, scientific research ability, and feedback results of teaching quality were compared between the two groups.Results:After intervention, the total score of assessment in the observation group was (90.62 ± 4.75) points, higher than that in the control group (83.84 ± 5.01) points, there was significant difference ( t=5.46, P<0.05). After intervention, the scores of observation ability, operation ability and teamwork ability in the observation group were (3.51 ± 0.59), (3.75 ± 0.50), (4.30 ± 0.77) points, higher than those in the control group (3.18 ± 0.44), (3.22 ± 0.46), (3.53 ± 0.81) points, there were significant differences ( t=2.51,4.35, 3.83, all P<0.05). After intervention, the scores of clinical communication and keen listening, determining patients′ problems, participating together, sending effective information, establishing harmonious doctor-patient relationship, and verifying perception ability in the observation group were (83.61 ± 10.18), (81.66 ± 8.92), (84.01 ± 9.17), (83.25 ± 9.73), (80.90 ± 9.99), (84.15 ± 8.08) points, higher than those in the control group (73.91 ± 9.73), (74.95 ± 8.05), (76.02 ± 8.22), (73.16 ± 8.02), (74.61 ± 8.54), (76.08 ± 8.25) points, there were significant differences ( t values were 2.67-4.47, all P<0.05). After intervention, the scores of literature reading ability, data processing ability and paper writing ability in the observation group were (14.29 ± 1.54), (13.02 ± 1.29), (14.91 ± 1.50) points, higher than those in the control group (13.08 ± 1.43), (11.44 ± 1.24), (12.36 ± 1.28) points, there were significant differences ( t=3.21, 4.92, 7.22, all P<0.05). The feedback scores of students about improving nursing humanistic quality, professional self-identity, learning interest, communication ability, clinical thinking ability and innovation ability in the observation group were (4.26 ± 0.75), (4.43 ± 0.81), (4.25 ± 0.77), (4.18 ± 0.66), (4.44 ± 0.90), (4.38 ± 0.94) points, higher than those in the control group (3.51 ± 0.64), (3.79 ± 0.70), (3.48 ± 0.84), (3.40 ± 0.76), (3.83 ± 0.89), (3.60 ± 0.89) points, there were significant differences ( t values were 2.68-4.30, all P<0.05). Conclusions:The interactive communication mode combined with problem-based learning can effectively improve assessment results of undergraduate nursing students, and promote the improvement of their comprehensive quality, which is conducive to the improvement of clinical communication ability and scientific research ability in nursing students.

目的 探讨卓越教学法配合微信平台在呼吸科护生临床带教中的应用及对护生综合能力的影响.方法 选取2018年3月至2020年11月在北京积水潭医院呼吸科实习护生82例,随机分为对照组和观察组,各41例,对照组采用传统教学模式,观察组采用卓越教学法配合微信平台教学模式.比较两组护生带教学习后理论成绩、操作成绩、综合能力成绩、批判性思维能力评分和满意度评分以及出勤率.结果 带教结束后,观察组的理论成绩、操作成绩、综合能力成绩、批判性思维能力倾向测试量表评分和满意度量表评分以及出勤率高于对照组(P＜0.01,P＜0.05).结论 卓越教学法配合微信平台模式可以提高呼吸科护生的综合能力和批判性思维能力,提高临床带教的教学满意度以及出勤率.

Objective:This study aimed to investigate the functional and aesthetical outcomes after index pollicization for severe congenital thumb hypoplasia.Methods:From June 2010 to November 2018, 26 patients (29 hands) with Manske modified Blauth type ⅢB-V thumb hypoplasia who were admitted to Department of Hand Surgery, Beijing Ji Shui Tan Hospital were treated with index pollicization. Thumb abduction angles, Kapandji score, pinch forces, interphalangeal and metacarpophalangeal ranges of motion were measured. The stability of carpometacarpal joint was checked. Goldfarb function score and Likert scale score were used to evaluate overall function of thumb. Whether new first metacarpal’s physeal closure presence was observed on X-ray film. Postoperative complications were recorded. The patients’guardian’s and follow-up doctor’s subjective satisfactions on thumb appearance and function were surveyed. The correlation between guardian’s satisfaction and objective indicators, the differences between guardian’s and doctor’s satisfactions, the difference between operation satisfaction before and after 3 years old were analyzed.Results:Among 26 patients(4 type ⅢB, 16 type Ⅳ, and 9 type V), there were 19 males and 7 females with an average age of 37 months (range: 15-89 months) during surgery, including 8 left hands, 15 right hands and 3 bilateral hands. The average follow-up was 42 months. Average thumb radial abduction was 46.2°, average palmar abduction was 34.1°, and average Kapandji score was 7.1. Average angle of interphalangeal joint extension was 3.4°, flexion 40.7°, metacarpophalangeal joint extension 4.1°, flexion 38.6°. The average pinching forces (key pinch, tip pinch and tripod pinch) were 0.5 kg, 0.8 kg and 1.2 kg respectively. All carpometacarpal joints were stable. The average Goldfarb score was 4. The average Likert scale was 22. All epiphyses were open. First web contracture and superficial skin necrosis were respectively observed in 1 and 6 cases. There was no correlation between the guardian’s satisfaction and the objective indicators. The guardian’s satisfaction on thumb appearance and function was significantly lower than that of doctors’. There was no significant difference in guardian’s and physician’s satisfaction between patients before and after 3 years old.Conclusions:Satisfactory functional outcomes can be obtained after index pollicization for patients with Manske modified Blauth ⅢB-V thumb hypoplasia, with weak strength of thumb opposition and flexion. The subjective satisfaction of doctors was higher and that of guardians was lower.

Purpose: To investigate the overall quality of life level and identify influencing factors in patients with traumatic brachial plexus injury.Methods: One hundred three patients with brachial plexus injury were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Family Adaptability and Cohesion Evaluation Scale (FACESII-CV) questionnaires.Results: The overall quality of life score from patients with brachial plexus injury was 65.78 +/- 15.2. The scores for the physical, psychological and environmental factors were significantly lower than the norm (Ps < 0.05). Regression analysis showed that age, injury located ipsilateral to the dominant hand, upper limb function score, score of family intimacy and family income were all factors influencing the of quality of life.Conclusions: A brachial plexus injury significantly compromises an individual's quality of life. Multiple factors influence this quality, which should be targeted to augment the physical and psychological care provided. Copyright (C) 2014, Chinese Nursing Association. Production and hosting by Elsevier (Singapore) Pte Ltd. All rights reserved.

[目的]了解北京市某三级甲等医院骨科注册护士通用能力现状,为制定护理人力资源配置方案提供依据。[方法]应用一般资料调查表和通用能力量表对北京市某三级甲等医院骨科191名护士进行问卷调查。[结果]护士通用能力总分为(53.922±8.993)分,均分为(2.996±0.499)分。设计和创新能力得分最低,与他人相处和工作配合能力得分最高。不同科室、年龄、工作年限护士的对通用能力有影响。[结论]北京市某三级甲等医院骨科护士通用能力处于中等偏上水平,需加强低年龄、低职称、工作时间短的护士的通用能力培训,以提高护理队伍的通用能力。

<正>臂丛神经由第5—8颈神经和第1胸神经的前支组成;有时颈5接受颈4的部分神经纤维,胸1接受部分胸2的纤维,凡组成臂丛的神经受损伤均称为臂丛神经损伤[1],臂丛神经损伤是一种较难处理的周围神经损伤,常导致上肢的严重功

目的调查手部先天畸形的发生与围产期保健的关系,为临床有效预防或减少手部先天畸形的发生提供理论依据。方法本文对2010年12月至2011年12月至北京积水潭医院手外科就医的手部先天畸形的144病例进行问卷调查,探讨先天畸形发生与围产期保健的关系。结果 119例(82.64%)的患儿母亲进行正规的产检,所有进行正规产检的患儿母亲均进行B超进行畸形的筛查;16例(11.11%)患儿母亲进行过产前咨询,其中15例在产科门诊,1例在遗传门诊,咨询结果为正常或无定论;69例(47.92%)先天畸形出生时由医生发现,75例(52.08%)先天畸形出生后由患儿家属发现。结论手部先天畸形的产前检出率低;遗传咨询最好能在遗传门诊进行;需要加强产科医生对于手部先天畸形知识的培训。

总结了1例尖头并指(趾)畸形(Apert综合征)患儿围手术期的护理.术前进行全面评估,充分准备；术后严密观察病情,加强眼球突出的护理,控制疼痛,防止皮片坏死,预防感染,积极给予营养支持.患儿手术顺利,术后未发生眼球突出加重、皮片坏死、手术部位及供皮区的感染等并发症,术后第3日出院.

<正>臂丛神经损伤是一种难处理的周围神经损伤,常导致上肢的严重功能障碍,造成患者终身残疾,并产生严重的社会经济影响[1]。臂丛神经根性撕脱伤(BPA)是臂丛神经损伤类型中最为严重的一种[2],其对患者造成的伤害更为巨大。臂丛神经撕脱伤后,大多数患者饱受长期慢性疼痛的困扰[3-4]。这种长期的剧痛与传入神经阻滞有关。虽然这种疼痛和其管理的难度在国外已有较多报道[2-7],但国内鲜有关于这种疼

目的了解骨科护士对疼痛知识掌握的现状,为改进临床疼痛管理提供依据。方法以疼痛管理知识和态度调查问卷为基础设计骨科护士疼痛知识与培训需求调查问卷,对100名骨科护士进行调查。结果骨科护士疼痛知识总均分9.15±2.28,正确率为41.59%;不同病区、有无接受疼痛知识培训护士的疼痛知识得分比较,差异有统计学意义(P<0.05,P<0.01)。92.00%骨科护士认为有必要进行疼痛知识培训,培训周期以1个月(22.00%)和3个月(43.00%)为主,75.00%护士希望由专业机构进行培训。结论骨科护士疼痛知识缺乏,对疼痛培训需求高。建议加强疼痛知识规范化培训,提高骨科护士疼痛管理水平。

目的调查手部先天畸形的发生因素,为临床为了有效的预防或减少手部先天畸形的发生提供理论研究。方法本文对2010年12月至2011年12月至北京积水潭医院手外科就医的手部先天畸形的144病例进行问卷调查,探讨先天畸形发生的影响因素。结果 7例患者的父亲(4.86%)有手部的先天畸形,6例患者的母亲(4.2%)有手部的先天畸形;27例患者(18.8%)有家族遗传史;有24例母亲(16.67%)在孕期接触过环境危险因素。结论手部先天畸形的发生与遗传因素以及环境因素的关系较大,与父母亲的年龄关系不大。

<正>随着医学科学的发展,肝移植技术逐步得到完善,我科于2010年7月收治1例肝移植术后合并坐骨神经损伤病人,病人因患肢疼痛明显、功能障碍强烈要求手术,经精心护理,病人住院期间未发生并发症。现报道如下。

>臂丛神经损伤是一种较难处理的周围神经损伤,常导致上肢的严重功能障碍,造成患者终身残疾,并产生严重的社会经济影响。对臂丛神经损伤患者的治疗一直是骨科和手外科医生的难题,1966年巴黎骨科会议宣布臂丛神经损伤不可治愈。但是国内外的手外科医生们一直在探索治疗臂丛神经损伤的方式,通过显微外科手术以多种不同的术式,可恢复患者的部分肢体功能,但是现存的术式都是以某

<正>健侧C7神经经椎体前路移位术治疗臂丛神经撕脱伤已在临床上广泛开展,并取得了较好的疗效[1-2],但经椎体前通路移位较传统的手术方法相对复杂并存在一定的风险。我科2002年2月～2009年8月完成该项手术共425例[3],现将护理体会报告如下。1临床资料1.1一般资料本组患者425例,其中,男379

<正>近年来,社会对护士需求量上升,护理就业岗位相对宽裕,但相当多的护理大毕业生表现出无所适从的现象,有的盲目跟从;有的过分强调到大医院就业;有的对自己估价过高,眼高手低[1]。因而,加强对护理大专毕业生的就业指导就显得尤为重要。本文通过用自行设计的调查问卷对76名大专生进行调查,了解目前护理大专生的就业观及其影响的因素,找出在就

<正>我院于2007-01-2010-05对16例小腿大面积缺损创面的患者使用背阔肌皮瓣移植修复创面,疗效非常满意。护理体会如下。1临床资料1.1一般资料本组男10例,女6例,年龄19~55(平均29.3)岁。本组均为因胫腓骨开放性骨折致软组织大量缺损导

<正>我院于2008-01-2011-01收治19例因工作不慎所致的优势手损伤而致功能障碍的患者,住院期间患者均出现一系列的心理问题乃至自杀倾向。护士运用Thorne精神支持疗法对患者进行心理干预,使其情绪稳定,积极配合治疗和护理,均在伤

<正>手术室历来是医院感染控制与监测的重点部门。我院是以骨科和烧伤为特色的三级甲等医院,现有创伤骨科、手外科、矫形骨科、脊柱外科、运动损伤科、小儿骨科以及骨肿瘤科等7个亚科。随着我院骨科分科越来越细,各专科的手术难度、精度增大,对我院手术室的感染控制与管理提出了更加严格的要求。我院手术室自2010年11月～2011年10

用移植皮瓣修复皮肤缺损在国内外已广泛应用.腹部皮瓣互换术是将手部瘢痕切除时形成一瘢痕瓣,在腹部形成皮瓣后两个皮瓣的蒂部均位于创面的同一侧,供区用瘢痕瓣覆盖,受区用新形成的皮瓣覆盖[1].