系统性红斑狼疮患者合并巨大肩袖损伤的观察与护理

Observation and Nursing of Massive Rotator Cuff Tears Combined with Systemic Lupus Erythematosus

摘要: 肩袖损伤常好发于中老年人，以肩关节疼痛、无力、活动受限为主要症状。肌腱断裂大于5毫米者称为巨大肩袖损伤。近年来，关节镜下肩袖修补术在临床上得到广泛应用。镜下治疗肩袖损伤对组织损伤小，术后可进行早期功能锻炼。系统性红斑狼疮是一种自身免疫性疾病，病程迁延不愈，且目前无根治方法。两种疾病合并一起使患者生理和社会功能都受到影响，生活质量下降。很多患者因担心手术使红斑狼疮加重，只单纯的进行保守治疗，最后导致肩关节损伤加重，形成巨大肩袖损伤，无法进行日常生活。随着医学模式的转变，生活质量成为各国医务工作者的研究热点。2013年9月，我院收治一例巨大肩袖损伤合并红斑狼疮的患者,长期服用强的松，因担心手术会使加重病情，一直在当地医院进行保守治疗，效果很差，患者患肢活动障碍，肩关节前屈上举85˚，外旋15˚，无法进行正常活动，生活质量严重下降。经他人介绍，转来我院治疗。护士对患者术前术后的常规护理，术后体位的安置及肩关节外展包制动的指导，在进行骨科常规护理时着重加强皮肤护理，在不影响手术的前提下避免皮肤刺激，观察并发症的同时注意鉴别症状引起原因，对症处理。患者肩关节恢复良好，未因手术创伤使原始疾病加重。

Abstract: Systemic lupus erythematosus (SLE) is a kind of autoimmune disease, which is difficult to treat clinically nowadays. Rotator cuff tears (RCT) are more common in elder patients, many of whom would complain about pain, stiffness and weakness. The combination of the above two diseases could cause severe functional loss of the quality of life to the patient. In recent years, the treatment of arthroscopic surgeries for RCT is well developed. With the minimal invasion of the arthroscopic surgery, post-operative rehabilitation could be applied earlier. However, many of the patients would worry about that the surgery may get SLE worse, and choose conservative treatment instead, which leads to progressing of the RCT. This article reports one patient with massive RCT combined with SLE, who was admitted into our ward in September 2013. Before the operation, the long-term conservative treatment resulted in a poor clinical function of the shoulder joint and bad condition of quality of life. The forward elevation was 85˚, and the external rotation was 15˚. After the surgery, the patient received a careful clinical nursing. The shoulder was immobilized onto an abduction pad. The nursing for skin pressure was emphasized as well as other routine clinical health care. The rehabilitation program was well applied. The patient recovered well, and there was no complication found.