Patterson Miki
University of Massachusetts Graduate School of Nursing, Department of Orthopedics, UMass Memorial Medical Center, Worcester, MA, USA.
Orthop Nurs. 2006 Sep-Oct;25(5):300-8; quiz 309-10. doi: 10.1097/00006416-200609000-00005.
To define the state of nursing knowledge about the psychological impact of treating adolescents with external fixation devices (EFDs).
An integrated research review was conducted on literature available from CINAHL, MEDLINE, and PsycINFO. Keywords used were external fixation, fracture fixation, orthopaedic or orthopaedic, limb lengthening, Ilizarov, halo traction, Orthofix, EBI fixator, pelvic fixator, ring fixator, body image, self-concept, self-esteem, self-perception, adaptation, emotional, behavior, and outcome. Inclusion criteria for studies were (a) publication from 1990 to 2003, (b) focus on psychosocial and functional outcomes of treating adolescents with EFDs, and (c) publication in English. Studies were categorized by author, year, discipline(s), design, focus, sample, measurement, findings, and research recommendations. Findings and recommendations were compared across publications.
All studies reported psychological and behavioral changes after EFD treatment. Pain and pin-site infections were the most problematic physical findings. Depression was universally evident to varying degrees, with some suicidal ideation and self-destructive behaviors, although mostly reported as transient. This predominantly retrospective cohort of studies reported social isolation as well as eating and sleep disturbances. Family and nursing support, a multiple disciplinary approach, and better preoperative preparation were crucial to adolescents psychological health after EFD treatment.
Adolescents treated with EFDs require significant psychosocial support. The findings reveal major gaps in the knowledge on adolescents treated with external fixation for traumatic injury and none focused on EFD treatment in the acute period.
明确护理人员对使用外固定装置（EFDs）治疗青少年的心理影响的认知状况。
对CINAHL、MEDLINE和PsycINFO数据库中可得的文献进行综合研究综述。使用的关键词包括外固定、骨折固定、矫形或矫形外科、肢体延长、伊里扎洛夫技术、头环牵引、奥托法克斯固定器、EBI固定器、骨盆固定器、环形固定器、身体意象、自我概念、自尊、自我认知、适应、情绪、行为及结果。研究的纳入标准为：（a）1990年至2003年发表；（b）关注使用EFDs治疗青少年的心理社会和功能结局；（c）英文发表。研究按作者、年份、学科、设计、重点、样本、测量、结果及研究建议进行分类。对各出版物的结果和建议进行比较。
所有研究均报告了EFD治疗后青少年的心理和行为变化。疼痛和针道感染是最突出的身体问题。抑郁在不同程度上普遍存在，伴有一些自杀意念和自我毁灭行为，不过大多报告为短暂性的。这一主要为回顾性队列研究表明存在社会隔离以及饮食和睡眠障碍。家庭和护理支持、多学科方法以及更好的术前准备对EFD治疗后青少年的心理健康至关重要。
接受EFDs治疗的青少年需要大量心理社会支持。研究结果揭示了在创伤性损伤使用外固定治疗青少年方面的知识存在重大空白，且没有研究聚焦于急性期的EFD治疗。
