AbstractBackgroundData on the epidemiological characteristics and prognostic factors of patients with pelvic fractures are lacking, particularly in China. This study aimed to summarise the clinical and epidemiological characteristics of patients with pelvic fractures in eastern Zhejiang Province, China, and to identify risk factors for poor prognosis.MethodsThe clinical data of 369 patients with pelvic fractures admitted to the Ningbo No. 6 Hospital between September 2020 and September 2021 were retrospectively analysed. Data on the demographic characteristics; fracture classification; injury time, cause, and site; treatment plan; and prognosis were collected using the Picture Archiving and Communication System and the Hospital Information System. Differences in constituent proportions were analysed using the chi-square test. Logistic regression analysis was used to identify factors affecting patient prognosis. Statistical significance was set at p ≤ 0.05.ResultsAmong the 369 patients, there were 206 men and 163 women, at a ratio of 1.26:1, and the average age was 53.64 ± 0.78 years. More than 50% of patients were aged 41–65 years. The average length of hospital stay was 18.88 ± 1.78 days. The three most common causes of pelvic fractures were traffic accidents (51.2%), falls from height (31.44%), and flat-ground falls (14.09%). There were significant differences in the distribution of the three causes of injury depending on age (p < 0.001), sex (p < 0.001), and occupation (p < 0.0001). Most patients were manual workers (48.8%). Furthermore, most patients (n = 262, 71.0%) underwent surgical treatment for pelvic fractures. Postoperative complications occurred in 26 patients (7.05%), and infection was the main complication (73.08%). Age (p = 0.013), occupation (p = 0.034), cause of injury (p = 0.022), treatment options (p = 0.001), and complications (p < 0.0001) were independent factors affecting the prognosis of patients with pelvic fractures. One death (0.027%) occurred, which was due to severe blood loss.ConclusionsAge, occupation, cause of injury, treatment options and complications were factors affecting patient prognosis. In addition, changes in blood flow and prevention of infection warrant attention.

综述"互联网+"在脆性骨折风险评估、骨质疏松症诊断及脆性骨折居家康复锻炼、脆性骨折预防中的应用,以期为后续相关研究和临床应用提供参考.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

目的:从内植物技术角度剖析髋臼骨折后方接骨板内固定手术的失败原因及解决方法.方法:回顾性分析2011年1月至2021年12月,从国内10家医院收集的行全髋关节置换术(THA)治疗的髋臼骨折后方接骨板内固定术后创伤性关节炎患者的临床资料.男24例,女3例;年龄37～62岁,平均(49.5±1.2)岁.内固定手术至THA的时间为8～42个月,中位数18.0(16.9,18.3)个月.调阅患者的住院病历、THA手术前后的X线和CT检查资料,从内植物并发症、髋关节骨结构损伤两个层面进行分析.结果:左侧固定77.8%(21例),右侧固定22.2%(6例).1块重建接骨板固定40.7%(11例)、2块重建接骨板固定55.6%(15例)、4块重建接骨板固定3.7%(1例);螺钉固定数量每例4～15枚.内植物并发症:内植物侵蚀股骨头33.3%(9例)＞螺钉滑脱11.1%(3例)＞螺钉断裂3.7%(1例).骨结构损伤:股骨头骨缺损96.3%(26例)＞负重区关节面塌陷+后壁骨吸收/坏死77.8%(21例)＞股骨头脱位70.4%(19例)＞负重区关节面塌陷63.0%(17例)＞后壁外缘骨块吸收/坏死55.6%(15例)＞关节内骨赘增生11.1%(3例)＞髋臼硬化7.4%(2例)、囊性变7.4%(2例).未有效固定部位:负重区+后壁70.4%(19例)＞负重区63.0%(17例)＞后壁55.6%(15例)＞后柱7.4%(2例).结论:负重区+后壁关节面骨块未有效固定是导致后方内植物失败的关键因素,内植物失败并发症和骨结构损伤与接骨板螺钉分布直接相关.

目的 观察改良式芒硝袋联合生物冰袋对上肢闭合性骨折患者消肿止痛的应用疗效.方法 采用方便抽样法,选取上肢闭合性骨折患者60例,按照入院先后顺序分为观察组和对照组各30例.观察组采用改良式芒硝袋联合生物冰袋交替外敷,对照组采用生物冰袋持续冷敷.比较两组患者疼痛程度、周径差变化.结果 两组患者的疼痛评分及上肢周径差在时间、组间、时间×组间交互效应比较,差异均有统计学意义(P<0.05).结论 对上肢闭合性骨折患者使用改良式芒硝袋联合生物冰袋外敷的消肿止痛效果优于单纯生物冰袋.

Urinary retention is a common complication of bedridden patients in traumatic orthopedics. The severe condition can even cause permanent bladder injury and renal failure, which brings great pain and psychological pressure to patients and seriously hinders their rehabilitation. The traditional Chinese medicine appropriate technologies have the characteristics of safety, effectiveness, low cost, simplicity and easy learning and achieve good clinical effects in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopaedics, including Chinese herbal medicine, acupuncture and moxibustion, massage, etc. The authors summarize the research progress in appropriate technologies of traditional Chinese medicine in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopedics from aspects of action principles, operation methods and effects of acupuncture points, moxibustion therapy, manipulation therapy, external treatment of traditional Chinese medicine and acupoint injection, so as to provide a reference for further nursing research and clinical application.

多指畸形是临床常见的儿童先天性手部畸形.VATER联合征是临床罕见的一系列畸形组合疾病,指人体六大系统的先天发育异常、脊椎异常、肛门闭锁、心脏畸形、气管食管畸形、肾脏异常、肢体畸形中3种及以上畸形同时存在.患儿畸形器官须经多次手术方能获得生理功能,因畸形严重程度不同而预后不一.

目的 观察多切口肝素冲洗多切口肝素冲洗在穿支皮瓣移植术后早期淤血危象中的应用效果.方法2018年8月-2020年3月我科将多切口肝素冲洗法应用于12例四肢外伤穿支皮瓣移植术后淤血危象治疗及护理中.发现皮瓣淤血危象立即汇报主管医师.处理措施为:(1)放平患肢,静脉滴注尿激酶.(2)协助医师在无菌原则下拆开皮瓣边缘或血管蒂部缝线,并于血管蒂部注射罂粟碱30 mg.(3)多切口肝素冲洗.(4)遵医嘱予低分子肝素钙4100 U皮下注射1次/d,罂粟碱30 mg肌内注射,q 6 h.同时注意观察皮瓣血运变化及预防并发症.结果本组12例患者通过多切口肝素冲洗法配合抗凝、抗痉挛药物治疗4～6 h后皮温升高至34～36℃,毛细血管返流时间恢复至正常,切口流出血液逐渐由暗红色转为鲜红色,流出速度亦逐渐加快,本组患者均未采用手术干预而成活.本组患者均获得随访,随访时间为3～15月,患者皮瓣恢复良好,未出现其他并发症.结论多切口肝素冲洗法应用于穿支皮瓣移植术后早期淤血危象治疗及护理中,能够有效救治淤血危象.

总结1例足趾移植再造拇示指术后因负性情绪再造指发生异常运动的叙事护理体会.主要护理措施包括与患者深度沟通,通过叙事了解患者面临的护理问题,进行外化、解构护理问题,帮助患者改写故事,改善患者焦虑、抑郁等负性情绪及睡眠障碍,有效阻止再造指异常运动,保障治疗顺利进行.术后2周,患者恢复良好予以出院.

目的观察脊髓损伤患者实施多学科团队综合康复干预的效果.方法2017年1—12月宁波市第六医院收治的脊髓损伤患者80例,随机分为观察组与对照组各40例.对照组予常规康复治疗和护理,观察组在对照组基础上予多学科团队综合康复干预,比较两组干预前后躯干控制能力、肌力、运动功能及日常生活能力变化.结果观察组躯干控制能力量表、肌力、Fugl-Meyer运动量表、改良Barthel指数评分明显高于对照组,差异均有统计学意义(P<0.05).结论脊髓损伤患者经过多学科团队综合康复干预,可提高躯干控制能力和肌力,改善运动功能和日常生活能力.

目的 了解下肢骨牵引患者治疗期间的体验及需求,为有效护理下肢骨牵引患者提供参考.方法 选取住院行下肢骨牵引的12例患者为研究对象,进行深度访谈,依据质性研究内容分析法结合Nvivo 11.0软件分析资料.结果 通过分析资料得出4个主题:多重情绪体验,负性生理体验,疾病相关知识缺乏,车祸伤患者医疗费解决困难.结论 下肢骨牵引患者承受着心理及生理等多重压力,护士应关注患者的心理变化.

目的 建立以能力为导向的骨科专业护士核心能力架构指标体系,明确骨科专业护士资质.方法 采用德尔菲专家咨询法对35位专家进行2轮专家咨询,确定骨科专业护士核心能力评价指标体系的各级指标构成及概念.结果 构建了由3个一级指标、10个二级指标、68个三级指标组成的骨科专业护士核心能力架构指标体系,明确工作＞5年且骨科专科工作满2年的护士为骨科专业护士.35位专家积极程度、权威系数较高,专家意见的协调性好,CV小,差异有统计学意义(P＜0.05).结论 骨科专科护士杨心能力各级指标专家意见集中,研究结果可信度高,所构建的指标体系为骨科专业护士的培养、考核和评价提供了可量化的依据,具有较强的现实指导意义.

目的 探讨格林模式对跟骨骨折患者术后康复锻炼依从性的影响.方法 选择2017年1-8月我院足踝外科跟骨骨折手术患者98例,按入院先后分为对照组和观察组各49例,对照组实施常规康复锻炼指导,观察组在常规的基础上加用格林模式.比较两组患者的跟骨骨折康复锻炼依从性及相关知识、态度和信念、行为问卷水平.结果 观察组的康复锻炼依从性以及相关知信行问卷分数均高于对照组(P＜0.05).结论 采用格林模式对跟骨骨折患者进行康复锻炼指导能够提升患者术后康复锻炼依从性及相关康复锻炼知识、态度、行为的水平,进而加快患者足踝功能的恢复.

胸腰椎骨折常合并脊髓损伤,导致损伤水平以下运动、感觉、自主神经功能的障碍,脊髓损伤(SCI)是指由于各种外力作用于脊柱所造成的脊髓压迫或断裂.随着社会发展,各种交通、建筑等方面的危险随之而来,这使得脊髓损伤的发病率进一步的增高[1].这种疾病往往发病突然、伤情严重而复杂,并发症多,易致终生残疾,不仅严重影响患者的生活质量,也给家庭及社会带来沉重的负担.因此,本研究着重探讨康复护理干预对胸腰椎骨折合并脊髓损伤患者的临床作用.报道如下.

目的 观察快速康复外科(FTS)护理对跟骨骨折患者围术期疼痛的干预效果.方法 选取2016年9月至2017年2月收治的围术期采用常规护理跟骨骨折患者50例为对照组,2017年3至9月收治的采用FTS护理跟骨骨折患者50例为观察组.两组患者均行切开复位内固定术治疗.观察并比较两组患者入院时与术后1、2、3d疼痛评分(数字评估法).结果 两组患者入院时疼痛评分比较差异无统计学意义(P ＞0.05),观察组患者术后1、2、3d疼痛评分均低于对照组,差异均有统计学意义(均P＜0.05).结论 FTS护理可有效降低跟骨骨折患者围术期疼痛程度,值得临床推广应用.

医院火灾危害极大，如2005年12月15日吉林省辽源市中心医院发生火灾，造成39人遇难；2012年12月印度一家医院发生火灾，造成91人死亡。医院高层住院病区更是住院患者聚集的场所，垂直疏散距离长，一旦发生火灾，火势很容易在各楼层间蔓延扩散，造成人员伤亡及财产损失。火灾时人们常因惊恐和受“从众心理”驱使，争相逃命，发生拥挤、踩踏、甚至跳楼，极易造成群死群伤的严重后果[1]。我院针对火灾后如何灭火进行过多次应急演练，但是针对高层住院病区发生火灾后住院患者如何营救和疏散，护理人员知晓率仅10%（来自护理部的问卷调查，20/200），存在明显不足。暴露出来的问题有：人员分工不明，转运消防路径不知，转运准备不足，消防设施使用不熟练等。

Objective To discuss the core competence of nurses from orthopedic department in Ningbo and its influencing factors,in order to provide basic materials and evidence-based reference for the suitable al-location of human resources and set core competence hierarchy training plan.Methods By convenience sampling,426 nurses were selected and investigated by the scale of Chinese competency inventory for reg-istered nurses.Results Nurses of the primary title and limited working year accounted for 73.9% and 77.7%,respectively.The mean competency score was 139.8±38.9,which was in the middle-low level.The score of legal/ethical practice dimension scored the highest,followed by interpersonal relation,leadership, clinical care,professional development,teaching-coaching,critical thinking and research ability.The top three scored dimensions were taking responsibility for one’s own performance,recognizing other’s contri-butions and achievements and respecting the patient’s/client’s right to privacy,respectively.The bottom three were incorporating relevant research findings into nursing practice,initiating the appropriate orienta-tion programs for new nurses and acting as a change agent for the integration of new concepts and time. Age,working years,positional titles and education background were the most important factors affecting the competency score.Conclusion The core competency of nurses from orthopedic department in Ningbo is in the middle-low level,and has room of improvement.Working years,positional titles and education back-ground are the important factors affecting the competency score.The cultivation of critical thinking and research ability,teaching-coaching and professional development should be emphasized.

Objective To observe the effect of different methods of cleaning and disinfection on hospital air conditioning ventilation systems,provide the basis for choosing the best method for cleaning and disinfection. Methods Quantitative bacterial detection method was used to observe the wiping,brushing method and scrubbing disinfectant wiping method for the cleaning and disinfecting effect on a hospital air conditioning system vents and return air filters. Results Using a towel moistened with water,the exceeding rate of the total number of bacteria after cleaning was 93. 5%. The detection rate of Staphylococcus aureus and Staphylococcus epidermidis were 100% and 57. 1% respectively. And after running water scrubbing the air filter,the exceeding rate of the total number of bacteria after cleaning was 90. 3%. The detection rate of Staphylococcus aureus and Staphylococcus epidermidis were 64. 3% and 28. 5% respectively. After scrubbing with flowing water, wiping the filter surface with 500mg / L chlorine disinfectant,1 000 mg / L benzalkonium bromide and 5 g / L of peracetic acid solution respectively,the total number of bacteria were all 5 cfu / cm2,all meet disinfection eligible requirements. Conclusions The hospital air conditioning system vents and return air filters should be brushed with running water firstly and then wiped with a disinfectant solution after demolition,then it can meet the disinfection requirements.

目的 探讨丙泊酚在ICU躁动患者行心电导联型PICC置管中的应用效果.方法 30例ICU接受心电导联型PICC置管的躁动成年患者,分为丙泊酚组和咪达唑仑组,各15例.观察两组药物的镇静起效时间、达到理想镇静效果时间、停药后苏醒时间、PICC操作时间及药物不良反应.结果 丙泊酚组药物起效时间、达到理想镇静效果时间、停药后苏醒时间、PICC操作时间均较咪达唑仑组短(均P＜0.05).结论 丙泊酚适合用于ICU躁动患者行心电导联型PICC置管术.