Osteointegracija - sistemi, zapleti in zdravstvena nega vstopnega mesta : diplomsko delo

Muršec, Aljaž (author), Pađen, Ljubiša (mentor), Pavlović, Monika (comentor), Hočevar Posavec, Bojana (reviewer)

Uvod: Amputacija je nepovratna odstranitev dela/-ov telesa, ki pacientu povzroči doživljenjsko omejitev. Osteointegracija spodnje okončine namenjena pričvrstitvi protetičnega uda je v svetu novejša metoda, saj se izvaja šele dve desetletji. V preostalo kost krna se integrira implantat, ki sega skozi kožo v zunanjost, kar pa predstavlja pot za vdor mikroorganizmov in posledično okužb. Kljub zapletom se kaže, da ima veliko prednosti in koristi za ljudi z amputacijo okončin. Pomembno vlogo pri tem imajo tudi izvajalci zdravstvene nege, ki so člani interdisciplinarnega zdravstvenega tima v procesu oskrbe pacienta pred, med in po operativnem posegu. Namen: Namen diplomskega dela je ugotoviti obstoječe osteointegracijske sisteme, ki se uporabljajo ter kakšne zaplete doživljajo pacienti po operativnem posegu. Prav tako želimo pojasniti, kakšno vlogo ima medicinska sestra pri zdravstveni negi vstopnega mesta implantata. Metode dela: Uporabljena je bila deskriptivna metoda s pregledom literature iskane v podatkovnih bazah PubMed in ScienceDirect. Rezultati: Najpogosteje se uporabljajo štirje osteointegracijski sistemi; Integrirana nožna proteza, Osteointegrirana protetična okončina, Osteointegrirana proteza za rehabilitacijo oseb po amputaciji uda in Naprava za stiskanje. Ugotovili smo, da imajo sistemi različne karakteristike, materiale, sestavne dele in rehabilitacijo po operativnem posegu. Pri vseh sistemih se je izkazalo, da se pri več kot 60% pacientov zapleti ne pojavljajo, v kolikor pa se, je najpogostejši površinska okužba vstopnega mesta implantata (od 21% do 26,7%). Vloga medicinske sestre je predvsem spremljanje krna, preventivno delo in zdravstvena vzgoja, lokalna oskrba vstopnega mesta implantata ter prepoznavanje zapletov. Razprava in zaključek: Uspešna osteointegracija zahteva celostno oceno pacienta, saj je pri nekaterih pacientih zaradi zdravstvenega stanja kontraindicirana. Raziskave na tem področju so omejene, najverjetneje zaradi kratkega trajanja uporabe te metode, vendar eksperimentalne raziskave delane na živalih ponujajo obetavne možnosti nadgradnje in preprečevanja zapletov na tem področju. Vključevanje zdravstvene nege v proces osteointegracije je pomembno dejstvo, saj so medicinske sestre tiste, ki so prisotne ob pacientu v vseh fazah obravnave. Verjamemo, da bo z današnjim hitrim razvojem v prihodnosti še mnogo novosti.

• Language: Slovenian
• Keywords: diplomska dela, zdravstvena nega, osteointegracijski implantati, oskrba rane, protetika, amputacija
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [A. Muršec]
• Year: 2023
• Number of pages: 34 str.
• PID: 20.500.12556/RUL-149097
• UDC: 616-083
• COBISS.SI-ID: 163204867
• Publication date in RUL: 03.09.2023

Secondary language

• Language: English
• Title: Osseointegration - systems, complications and nursing care of skin-pin : diploma work

Abstract

Introduction: An amputation is an irreversible removal of a body part, resulting in a lifelong disability. Osseointegration of the lower limb to fix a prosthesis is a newer method that has been practiced worldwide for only two decades. An implant is integrated in the remaining bone, which extends outward through the skin, providing an entry for microorganisms invasion and subsequent infection. Despite its complications, it appears to have many advantages for use in people with amputation. Nurses, who are members of the interdisciplinary team involved in the care of patients before, during, and after surgery, also play an important role. Purpose: The purpose of this work is to identify the existing osseointegration systems used and what are the complications following the procedure. It also aims to clarify the role of the nurse in the nursing care of the skin-pin. Methods: A descriptive method was used with literature review searched in PubMed and ScienceDirect databases. Results: Four osseointegration systems are most commonly used: integral-leg-prosthesis, the osseointegrated prosthetic limb, the osseointegrated prostheses for the rehabilitation of amputees and compression device. We have found that the systems have s have different characteristics, materials, components, and rehabilitation measures after surgery. All systems have been shown to have no complications in more than 60% of patients, but the most common complication were superficial infections of skin-pin (21% to 26,7%). The nurses’ role is mainly to monitor the condition of the stump, perform preventive work and educating the patient, provide local care of the skin-pin and detect complications. Discussion and conclusion: Successful osseointegration requires a holistic approach of the patient as it is contraindicated in some patients due to their health status. Research in this area is limited, most likely due to the short duration of application of this method, but experimental research in animals offers promising opportunities to improve and prevent complications in this area. The involvement of nurses in the process of osseointegration is an important aspect, as nurses are present with patients at all stages of treatment. We believe that there will be many more innovations in the future given today’s rapid development.

• Keywords: diploma theses, nursing care, osseointegration implants, wound care, prosthetics, amputation