| 罗霄,田莹,余波,等.手术护士在3D打印技术辅助营养不良型1型神经纤维瘤病脊柱侧凸矫形术中的配合.骨科,2018,9(6): 484-487. |
| 手术护士在3D打印技术辅助营养不良型1型神经纤维瘤病脊柱侧凸矫形术中的配合 |
| Theatre nurses cooperation in malnutrition neurofibromatosis type 1 scoliosis surgery with three-dimensional printing assistance |
| 投稿时间：2018-04-19 |
| DOI：DOI：10.3969/j.issn.1674-8573.2018.06.013 |
| 中文关键词: 3D打印技术 神经纤维瘤病 脊柱侧凸 矫形外科手术 手术室护理 专科护士 |
| 英文关键词: Three-dimensional printing technology Neurofibromatosis Scoliosis Orthopaedics procedures Operating room nursing Clinical nurse specialist |
| 基金项目:云南省科技厅昆医联合项目（2015FB036）；昆明医科大学第一附属医院护理科研基金（2018HL01Z） |
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| 中文摘要: |
| 目的 探讨3D打印技术辅助开展顶椎区精准置钉及矫形治疗营养不良型1型神经纤维瘤病（neurofibromatosis type 1, NF1）脊柱侧凸术中手术护士的配合作用。方法 2012年5月至2017年4月我院采用3D打印技术辅助开展顶椎区精准置钉及脊柱截骨矫形术治疗营养不良型NF1脊柱侧凸病人5例，其中男3例，女2例，年龄为11~20岁。均为明显的胸段锐性侧凸伴后凸，累及主胸段4~6个椎体。术前运用3D打印技术制定手术方案，术中3D打印技术辅助置钉及截骨（完全脱位病例行经后路全脊椎切除术）。手术护士术前配合医生进行手术模拟演练、特殊器械的准备、病人的访视，术中负责3D打印模型的管理及与术者的配合等。观察所有病人的手术时间、术中出血量、手术前后侧凸和后凸角度及置钉数。结果 5例病人均顺利完成手术，无神经损伤加重病例，1例胸膜破裂放置胸管引流。手术时间为（5.20±0.95） h（4.2~6.6 h）；术中出血量为（1 468±252） ml（1 200~1 800 ml）。侧凸Cobb角由术前的68.6°±15.2°改善至术后的33.1°±16.7°，后凸角由术前的53.5°±16.3°改善至术后的32.6°±16.6°，差异均有统计学意义（P均＜0.05）。结论 手术护士须从术前手术模拟演练开始全程参与，熟悉3D打印技术和术中模型使用技巧，才能最大限度地发挥3D打印技术降低手术风险、减少手术时间和术中出血的优势。 |
| 英文摘要: |
| Objective To investigate the theatre nurses cooperation effect in precise pedicle screw placement and spinal osteotomy surgery with three-dimensional printing assistance treated for malnutrition neurofibromatosis type 1 (NF-1) scoliosis. Methods From May 2012 to April 2017, 5 patients with malnutrition NF-1 scoliosis were treated with precise pedicle screw placement and spinal osteotomy under the assistance of 3D printing technology, there were 3 males and 2 females, aged from 11 to 20 years. All of them were obvious thoracic scoliosis with kyphosis, involving 4-6 main vertebrae segment. The operation plan was made by 3D printing technique before operation, and intraoperative 3D printing technique was used to assist nailing and osteotomy (posterior total vertebral resection was performed in cases of complete dislocation). Theatre nurses cooperate with doctors to perform simulated drills, prepare special instruments, visit patients, manage 3D printing model, and cooperate with surgeons during operation. The operative time, intraoperative blood loss, scoliosis and kyphosis angle, and number of screws were observed. Results The operation was successfully completed in all the 5 patients, no nerve injury aggravated, and thoracic drainage was placed in 1 case of pleural rupture. The operation time was (5.2±0.95) h (4.2-6.6 h), and the intraoperative bleeding volume was (1 468±252) ml (1 200-1 800 ml). The scoliosis angle was improved from 68.6°±15.2° to 33.1°±16.7°, and the kyphosis angle was improved from 53.5°±16.3° to 32.6°±16.6°, with significant difference (P＜0.05). The average number of screw placement in the apical region was (5.2±2.7) with the help of the guide plate, which significantly increased the anchorage point. Conclusion The theatre nurses needs to participate in the whole process from the preoperative surgical simulation, and should be familiar with the 3D printing technology and the use of intraoperative models, so as to maximize the advantages of 3D printing technology to reduce the operation risk, the operation time and intraoperative bleeding. |
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