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外伤是导致颈椎骨折最主要的原因,当受到屈曲暴力时极易合并脱位,骨折大部分伴有脊髓损伤,可能造成高位截瘫甚至死亡[1],脱位严重者合并关节绞锁时常给骨折的复位造成困难。对于明确诊断为颈椎骨折伴脱位的病人,入院检查提示生命体征平稳后,常采取激素冲击、颅骨牵引辅助颈椎复位治疗,目的是为了尽快解除脊髓压迫、减轻脊髓损伤的炎症反应。颅骨牵引时常采用颈椎过伸的姿势,以期达到好的复位效果[2],其规范性和正确性直接关系到病人的生命安全及功能恢复[3]。传统的颈椎牵引体位是使病人仰卧位,床头抬高15°~20°,牵引时使用棉被或浴巾等柔软物品垫高病人肩部,颈部后伸20°[4-5]。但临床护理中发现, 肩背部所垫棉被或浴巾等柔软物品质软且容易塌陷、移位,无法达到有效支撑,病人不舒适,夜间睡眠质量差,甚至出现枕后及棘突处压力性损伤,严重影响牵引效果。为解决以上问题,我们自行设计了符合脊柱生理曲度、能给予有效支撑的“颈椎牵引体位垫”,以此辅助颅骨牵引治疗,可有效提高病人牵引过程中舒适度,减少病人痛苦及压力性损伤等并发症的发生。本研究旨在通过在临床行颅骨牵引时将其与传统填充物进行对比,分析二者舒适度及观察指标的差异,探讨颈椎牵引体位垫在临床应用中的优越性。
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观察组与对照组在牵引次日SF-McGill量表评分差异无统计学意义(P > 0.05),在牵引第4天及末次观察中,观察组的SF-McGill量表评分均低于对照组(P < 0.01)。观察组及对照组在牵引治疗期间压力性损伤发生率为9.4%(3/32)及37.5%(12/32),差异有统计学意义(P < 0.01)(见表 1)。
分组 n SF-McGill量表评分(x±s)/分 Ⅰ期压力性
损伤发生牵引次日 第4天 末次观察 观察组 32 32.0±2.8 25.3±2.7 21.8±1.8 3 对照组 32 32.6±2.6 27.3±1.6 24.1±2.0 12 t — 0.89 3.60* 4.83 7.05# P — > 0.05 < 0.01 < 0.01 < 0.01 *示t′值; #示χ2值 表 1 2组牵引期间SF-McGill量表评分及压力性损伤发生情况
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在舒适度的观察中,观察组的舒适度评分4(4,5)高于对照组2(2,3),差异有统计学意义(Z=6.51,P < 0.01)。
自制颈椎牵引体位垫在颈椎骨折伴脱位颅骨牵引治疗中的应用
Application value of self-made cervical traction pad in the skull traction treatment of cervical fracture complicated with dislocation
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摘要:
目的探讨自行设计的颈椎牵引体位垫在颈椎骨折脱位颅骨牵引治疗中的临床应用效果。 方法选取2016年1月至2020年2月安徽省阜阳市人民医院骨科脊柱创伤病区收治的64例外伤导致颈椎骨折脱位需行颅骨牵引治疗的病人,随机分为观察组和对照组,每组32例。其中对照组在行颅骨牵引时使用传统巾卷垫于颈部,肩背部垫棉被或浴巾等物品,使胸背部抬高。观察组采用自行设计的颈椎牵引体位垫。观察并收集牵引过程次日、第4天、末次观察时SF-McGill量表评估的牵引治疗过程中病人的疼痛程度、Ⅰ期压力性损伤发生率、舒适度,统计分析其差异性。 结果SF-McGill量表评分,观察组与对照组在牵引次日差异无统计学意义(P > 0.05),在第4天及末次观察中,观察组低于对照组(P < 0.01)。观察组压力性损伤发生率低于对照组,舒适度评分高于对照组,差异均有统计学意义(P < 0.01)。 结论自制颈椎牵引体位垫在病人牵引治疗中较传统填充可减轻病人疼痛程度,减少皮肤压力性损伤的发生,提高病人牵引过程中的舒适度。 Abstract:ObjectiveTo investigate the application effects of self-made cervical traction pad in the skull traction treatment of cervical fracture complicated with dislocation. MethodsA total of 64 patients with cervical vertebra fracture complicated with dislocation caused by exceptional injury and requiring skull traction treatment in the Department of Orthopedics Spinal Trauma in Fuyang People's Hospital of Anhui province from January 2016 to February 2020 were investigated, and randomly divided into the observation group and control group(32 cases in each group). The control group was treated with the traditional towel roll to pad the neck and quilts or bath towels to pad the shoulder and back for raising the chest and back during skull traction. The observation group was treated with the self-designed cervical traction pad. The SF-McGill scale was used to evaluate the pain degree, incidence of stage Ⅰ stress injury and comfort level of patients on the next day, fourth day and last observation during traction treatment, and the differences of which were statistically analyzed. ResultsThe difference of the SF-McGill scale score on the second day of traction was not statistically between two groups(P > 0.05), and the SF-McGill scale scores in observation group on the fourth day and last observation of traction were lower than that in control group(P < 0.01). The incidence rate of stress injury and comfort score in observation group were lower and higher than that in control group, respectively(P < 0.01). ConclusionsCompared with traditional filling, the self-made cervical traction pad can reduce the pain degree and occurrence of skin pressure injury, and improve the comfort level of patients in the process of traction. -
Key words:
- skull traction /
- bed care /
- cervical traction pad
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表 1 2组牵引期间SF-McGill量表评分及压力性损伤发生情况
分组 n SF-McGill量表评分(x±s)/分 Ⅰ期压力性
损伤发生牵引次日 第4天 末次观察 观察组 32 32.0±2.8 25.3±2.7 21.8±1.8 3 对照组 32 32.6±2.6 27.3±1.6 24.1±2.0 12 t — 0.89 3.60* 4.83 7.05# P — > 0.05 < 0.01 < 0.01 < 0.01 *示t′值; #示χ2值 -
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