Clinical pathway for developmental hip dislocation (over 2 years old)
(2010 version)
I. Developmental hip dislocation (over 2 years old) clinical pathway standard inpatient procedure
(A) Applicable objects.
First diagnosis of developmental hip dislocation (congenital hip dislocation) (ICD-10:Q65.0/Q65.1), age above 2 years and below 8 years, involving unilateral or bilateral.
Hip arthrotomy, pelvic osteotomy/acetabularplasty (femoral short rotation osteotomy) (ICD-9-CM-3: 79.85, 77.29/77.25) + plaster fixation was performed.
(ii) Diagnostic basis.
According to the Clinical Diagnosis and Treatment Guide-Pediatric Surgery (edited by Chinese Medical Association, People’s Health Publishing House), Clinical Technical Practice Guidelines-Pediatric Surgery (edited by Chinese Medical Association, People’s Military Medical Publishing House), Pediatric Surgery (edited by Shi Chengren et al., People’s Health Publishing House, 2009, 4th edition), Pediatric Surgery (planned textbook of Ministry of Health) -Teaching materials for higher medical schools, People’s Health Publishing House), Tachdjian Pediatric Orthopedics (Harcourt Scientific Health Publishing House, 6th edition, 2006).
1.Presentation: unequal limb length, walking limp or swaying gait.
2.Physical examination: endocannabinoid tension, positive Allis sign (unilateral lesion), positive Trendelenburg sign.
3.Pelvic orthopantomogram: the femoral head is located in the outer upper or lower quadrant of Pekin’s square, the acetabulum is shallow and flat, and a false socket is formed.
4.Three-dimensional CT of the hip joint: if necessary.
(iii) The basis for choosing the treatment plan.
According to the Clinical Diagnosis and Treatment Guide-Pediatric Surgery Sub-volume (edited by Chinese Medical Association, People’s Health Publishing House), Clinical Technical Practice Specification-Pediatric Surgery Sub-volume (edited by Chinese Medical Association, People’s Military Medical Publishing House), Pediatric Surgery (edited by Shi Chengren, etc., People’s Health Publishing House, 2009, 4th edition), Pediatric Surgery (Ministry of Health Planning Textbook) -(Teaching materials for higher medical schools, People’s Health Publishing House), Tachdjian Pediatric Orthopedics (Harcourt Scientific Health Publishing House, 6th edition, 2006).
Hip resurfacing, pelvic osteotomy/acetabularplasty (femoral short rotation osteotomy) (ICD-9-CM-3: 79.85, 77.29/77.25) + plaster fixation were performed.
(iv) The standard hospital stay is 10C12 days.
(E) Entry pathway criteria.
1. The first diagnosis must be in accordance with ICD-10:Q65.0/Q65.1 developmental hip dislocation disease code.
2, The child’s age is above 2 years old and below 8 years old.
3.Bilateral lesions are operated unilaterally.
4.When the child is combined with other diseases but does not need special treatment during hospitalization and does not affect the implementation of the clinical pathway of the first diagnosis, it can enter the pathway.
(F) Preoperative preparation (preoperative evaluation) 3C4 days.
1. Required examination items.
(1) Routine blood, urine and stool, blood type, coagulation function, electrolytes, liver and kidney function, screening for infectious diseases, and blood preparation.
(2) Chest X-ray, electrocardiogram.
(3) Orthopantomogram of the pelvis.
(2) Optional examination items according to the patient’s condition: three-dimensional CT of the hip joint.
(vii) Preventive antimicrobial drug selection and timing of use.
1.Select medication (recommended medication and dose) in accordance with the Guidelines for Clinical Application of Antimicrobial Drugs (Health Medical Development [2004] No. 285).
2.Recommended drug treatment plan (use of drugs from “National Essential Drugs”).
3.Timing of use: 1 time intraoperatively and 3 days postoperatively.
(H) The day of surgery is the 4thC5th day of hospital admission.
1.Anesthesia mode: general anesthesia or combined anesthesia.
2.Surgical method: hip joint incision and reset, pelvic osteotomy/acetabularplasty (femoral short rotation osteotomy plate internal fixation) + plaster fixation.
3.Intra-operative device: Clinique pin/plate/homogeneous bone, etc.
4.Intraoperative medication: intravenous antibacterial drugs.
5.Blood transfusion: 1C2 units (if necessary).
(ix) Post-operative hospital recovery 4C5 days.
1.Checkup items that must be reviewed: blood routine, orthopantomogram of pelvis, liver and kidney function and electrolytes if necessary.
2. Postoperative medication: the application of intravenous antimicrobial drugs is carried out in accordance with the Guidelines for Clinical Application of Antimicrobial Drugs (Health Medical Development [2004] No. 285).
(X) Discharge criteria.
1, normal body temperature.
2, dry incision without bleeding, infection, limbs without obvious swelling or blood supply disorders.
3.Postoperative review X-ray confirmed good femoral head reset and concentric head socket.
4.No complications and/or comorbidities that require hospitalization.
(XI) Variation and cause analysis.
1, Perioperative complications (incisional infection, re-dislocation, etc.) may cause prolonged hospital stay and increased costs.
2. For simultaneous surgery of bilateral lesions, transfer to other corresponding clinical pathways.
B. Clinical pathway form for developmental hip dislocation (over 2 years old)
Applicable target: First diagnosis of developmental hip dislocation (ICD-10:Q65.0/Q65.1)
Arthrotomy, pelvic osteotomy/acetabularplasty (femoral short rotation osteotomy) (ICD-9-CM-3: 79.85, 77.29/77.25) + plaster fixation
Patient’s name: Sex: Age: Clinic number: Hospitalization number
Date of hospitalization: year month day Date of discharge: year month day Standard hospital days: 10C12 days
Time
Day 1 of hospitalization
Day 2
Hospitalization day 3
Main treatment work
□ Asking medical history and physical examination
□ Preliminary diagnosis and treatment plan
□ Resident completes case writing such as hospitalization log, first course of illness, and upper-level physician visits
□ Complete preoperative examination
□ Visits by higher-level physicians
□ Further improvement of preoperative examination
□ Awaiting preoperative examination results
□ Superior physician visit, preoperative evaluation
□ Decide on the surgical plan
□ explain perioperative precautions to the child’s family and sign the consent form for surgery, consent form for blood transfusion, consent form for self-financed supplies, etc.
□ The anesthesiologist sees the patient and signs the anesthesia consent form, etc.
□ Complete all preoperative preparations
Key medical orders
Long-term medical advice.
□ Secondary care
□ general diet
Temporary medical advice.
□ blood, urine, stool routine
□ Coagulation function
□ liver, kidney function
□ Infectious disease screening
□ Orthopantomogram of pelvis
□ Electrocardiogram
Long-term medical orders.
□ Secondary care
□ general diet
Long-term medical advice.
□ Secondary care
□ general diet
Temporary orders.
□ surgical orders, skin cleansing, etc.
□ Application of antibacterial drugs
□ Blood preparation
□ intraoperative film request form
Major nursing tasks
□ Admission education, introduction of medical and nursing staff, ward environment, facilities and equipment
□ Admission nursing assessment
□ Perform preoperative examination
□ Waiting for test results
□ Family communication
□ Pre-operative preparation
□ Remind the family of the child’s preoperative water fast
□ Pre-operative psychological care for the family
Disease variation record
□ None □ Yes, reasons.
1.
2.
□ No □ Yes, reasons.
1.
2.
□ No □ Yes, Reason.
1.
2.
Nurse
Signature
Physician
Signature
Time
Day 4 of hospitalization
(day of surgery)
Day 5 of hospitalization
(Post-operative day 1)
Hospitalization day 6
(Post-operative day 2)
Main treatment work
□ Surgery
□ explain to the child’s family about the procedure and postoperative precautions
□ Complete surgical records
□ Visiting the superior doctor
General status of the child, blood flow of the affected limb, toe movement
□ Visits by supervising physicians
Completion of routine course records
□ Observation of the general condition of the child after surgery
□ Incision condition
□ Plaster condition
□ Visits by supervising physicians
□ Completion of routine course records
Key medical advice
Long-term medical orders.
□ First level of care
□ Fasting
□ X-side hip arthrotomy, pelvic osteotomy/acetabularplasty, femoral short rotation osteotomy + plaster fixation under general anesthesia
□ Intravenous antibacterial drugs
□ attention to blood flow activity of the affected limb
□ Pay attention to plaster care
Temporary medical advice.
□ Intravenous fluid rehydration
□ Review blood count after transfusion
Long-term medical advice.
□ Secondary care
□ general diet
□ Antibacterial drugs
Temporary medical advice.
□ rehydration support
□ repeat blood tests
□ analgesia and other symptomatic management
Long-term medical advice.
□ Secondary care
□ universal diet
□ antibacterial drugs
Temporary medical advice.
□ rehydration support
□ Review of X-rays
Major nursing tasks
□ Monitoring of the child’s vital signs and respiratory status
□ Postoperative care
□ Postoperative antibacterial medication and rehydration
□ Pay attention to the general condition of the child
□ Postoperative care
□ Attention to limb blood flow and plaster care
□ attention to the general condition of the child
□ Post-operative care
□ Attention to limb blood flow and cast care
Disease variation record
□ None □ Yes, reasons.
1.
2.
□ No □ Yes, reasons.
1.
2.
□ No □ Yes, Reason.
1.
2.
Nurse
Signature
Physician
Signature
Time
Hospitalization day 7C9
(3C5th postoperative day)
Hospitalization day 10C12
(day of discharge)
Main treatment work
□ Supervising doctor’s visit
□ Hospitalist completes medical records
□ Incision dressing change (if necessary)
□ Visits by superior physicians for surgical as well as wound assessment, to determine if there are any surgical complications and poor wound healing, and to clarify whether to discharge
□ Complete hospitalization log, first page of case, discharge summary, etc.
□ Give explanation to family for follow-up consultation
Key medical advice
Long-term medical advice.
□ Secondary care
□ General diet
□ Antibacterial drugs
Discharge instructions.
□ Appointment for dressing change and stitch removal according to wound healing
□ Regular follow-up
□ Plaster care
Major nursing tasks
□ Observe changes in the child’s condition
□ Pay attention to the cast and the blood flow of the extremity
□ Pay attention to the cast and blood flow of the extremity
□ Guide the family in the discharge procedure
□ Discharge education
Disease variation record
□ None □ Yes, reasons.
1.
2.
□ No □ Yes, reasons.
1.
2.
Nurse
Signature
Physician
Signature