Construction And Preliminary Application Of Postoperative Continuous Care Program For Children With Developmental Hip Dysplasia

Objective:Based on literature review and Delphi method,the continuous care program for children with developmental hip dysplasia after surgery was constructed,and the program was applied to clinical nursing work to understand the impact of continuous care program on the prognosis of children with developmental hip dysplasia.Methods:1.Through literature review and Delphi,the continuous care program for children with developmental hip dysplasia after surgery was established.2.Adopting the method of experimental research,children with developmental hip dysplasia(DDH)who were hospitalized in the pediatric orthopedics department of a hospital from January 1,2021 to September 30,2021 and underwent initial surgical treatment were selected.Eventually,a total of 49 pairs of children and caregivers who met the study requirements were finally obtained.The children and their caregivers treated from January to March were divided into the control group(25 pairs),and the children and their caregivers treated from April to September were divided into the experimental group(24 pairs).The control group received routine post-discharge nursing intervention,including diet and life guidance,rest and activity guidance,rehabilitation guidance,follow-up guidance.Children in the experimental group were discharged from hospital after surgical treatment,and were given continuous nursing intervention until 6 months.The general information of the children and caregivers was collected through questionnaires,and the postoperative acetabular index of the affected side was collected through the imaging system.The imaging data of the children were observed 6-8 weeks,3 months and 6 months,and the efficacy was evaluated according to Severin imaging evaluation criteria.The patients’hip function at 6～8 weeks,3 months and 6 months after surgery was investigated through outpatient follow-up,and the improved Mc Kay hip function was used to score,and the incidence of postoperative complications was collected.The psychological status of caregivers was analyzed using the anxiety self-rating Scale.Then compare the differences in hip function,imaging changes,complications and anxiety scores of caregivers after continuous nursing intervention.The results were statistically processed by SPSS25.0,and P<0.05 was considered statistically significant.Results:1.The continuous care program for children with developmental hip dysplasia after surgery was formed,with 4 first-level items and 20 second-level items.2.The recovery rates of the two rounds of expert letter consultation were89.47%and 100.00%,and the positive coefficients of the two rounds of expert questionnaires were both more than 70%,indicating high enthusiasm of experts.The degree of coordination of expert opinions was expressed by Kendall’s coefficient(W),P<0.05 was considered statistically significant.In the two rounds of expert consultation,the coordination coefficients of first-level indicators were 0.262 and0.487(P<0.05);The coordination coefficients of secondary indexes were 0.212 and0.274(P<0.01).It shows that the experts’opinions on the index system framework tend to be basically the same and the framework system constructed is reliable.3.A total of 48 pairs of children and their caregivers completed the intervention and follow-up for 6 months,and 1 pair of children and their caregivers were lost to follow-up.There was no significant difference in gender,age,body weight,ethnicity,surgical site,surgical time,AI Angle 1 day after surgery and length of hospital stay between the two groups.There was no significant difference in age,place of residence and education of caregivers.4.The comparison of Severin imaging evaluation results between the two groups at 6-8 weeks,3 months and 6 months after surgery showed that Z value was-0.43,-1.20,-0.79,P value was 0.67,0.23,0.43,P>0.05,the difference was not statistically significant.5.The comparison of modified Mc Kay hip function score between the two groups at 6-8 weeks and 3 months after surgery showed that the Z value was 0 and-0.99,and the P value was 1 and 0.32,respectively,which were both P>0.05,the difference was not statistically significant.Comparison of modified Mc Kay hip function score between the two groups 6 months after surgery,Z=-2.21,P=0.03,P<0.05,the difference was statistically significant.6.The incidence of postoperative complications of joint stiffness,stress injury,joint re-dislocation and wound infection was compared between the two groups(X~2=1.82,P=0.92).7.Comparison of anxiety scores between the two groups,on discharge day,t=1.496,P=0.517,the difference was not statistically significant.Six months after surgery,the anxiety scores of caregivers in the two groups were compared t=2.423,P=0.000,P<0.05,and the difference was statistically significant.Compared with the anxiety scores of the caregivers in the control group at 6 months after discharge,t=4.478,P<0.05;Comparison of anxiety scores between the caregivers in the experimental group after discharge and 6 months after operation,t=3.843,P<0.05;With the change of time,the scores of both groups showed a downward trend.Conclusions:1.The development of postoperative continuity care program for children with developmental hip dysplasia is scientific and reliable.2.This protocol can be applied to clinical practice and provide a reference for the continuous care of children with developmental hip dysplasia after surgery.3.Continuous nursing intervention can improve the hip function of children with developmental hip dysplasia after surgery.4.Continuous nursing interventions can relieve anxiety of caregivers of children with developmental hip dysplasia.