護理師照護一位全髖關節置換術後病人。下列哪項措施對預防髖關節脫位最重要？

核心概念：全髖關節置換術（Total Hip Arthroplasty, THA）術後照護，重點在於預防髖關節脫位（hip dislocation）。 為何正確答案對： A. 使用外展枕維持病人腿部外展（Maintain the client's legs in abduction with an abductor pillow）：全髖關節置換術後，股骨頭（femoral head）被置入新的人工髖臼（acetabulum）。為了防止股骨頭從臼中滑脫（dislocation），術後需要嚴格避免某些動作，特別是髖關節的內收（adduction）、內轉（internal rotation）以及屈曲超過 90 度。外展枕（abductor pillow）能有效地將雙腿維持在外展（abduction）位置，防止上述危險動作的發生，是預防脫位最關鍵的措施。 為何其他選項錯： B. 鼓勵病人坐在較低的馬桶上（Encourage the client to sit on a low toilet seat）：坐在較低的馬桶上會迫使髖關節屈曲超過 90 度，這大大增加了髖關節脫位的風險。術後應使用加高馬桶座（raised toilet seat）或助行器輔助，以維持髖關節屈曲角度在安全範圍內。 C. 坐姿時交叉病人的腳踝（Cross the client's ankles while sitting in a chair）：交叉腳踝（crossing ankles）的動作會導致髖關節內收（adduction）和內轉（internal rotation），這兩個動作都是導致髖關節脫位的常見原因。 B. 在物理治療中執行患側髖關節的內轉（Perform internal rotation of the affected hip during physical therapy）：如前所述，髖關節的內轉是絕對禁止的動作，因為它會將股骨頭推向臼的後緣，極易造成脫位。物理治療的重點是安全的活動度練習，絕對要避免內轉。 臨床思路：此題考量「減低風險潛力」（Reduction of Risk Potential）領域，重點在於預防全髖關節置換術後最常見且嚴重的併發症——髖關節脫位。護理師必須清楚掌握術後保護髖關節的關鍵原則，並指導病人及家屬共同執行，以確保手術成功及病人安全。

Core concept: Postoperative care after total hip arthroplasty (THA), with emphasis on prevention of hip dislocation. Why the correct answer is right: A. Maintain the client's legs in abduction with an abductor pillow: After total hip arthroplasty, the femoral head is placed into the new prosthetic acetabulum. To prevent the femoral head from slipping out of the socket (dislocation), certain motions must be strictly avoided after surgery, particularly hip adduction, internal rotation, and flexion beyond 90 degrees. An abductor pillow can effectively keep the legs in abduction, preventing the above dangerous motions, making it the most important measure for preventing dislocation. Why the other options are wrong: B. Encourage the client to sit on a low toilet seat: Sitting on a low toilet seat forces the hip into more than 90 degrees of flexion, greatly increasing the risk of hip dislocation. A raised toilet seat or assistive walker should be used postoperatively to keep hip flexion within a safe range. C. Cross the client's ankles while sitting in a chair: Crossing the ankles produces hip adduction and internal rotation, both of which are common causes of hip dislocation. D. Perform internal rotation of the affected hip during physical therapy: As stated above, internal rotation of the hip is an absolutely prohibited motion, because it pushes the femoral head toward the posterior rim of the acetabulum and can easily cause dislocation. The focus of physical therapy is safe range-of-motion exercises, in which internal rotation must absolutely be avoided. Clinical reasoning: This question falls under the domain of Reduction of Risk Potential, focusing on the prevention of the most common and serious complication after total hip arthroplasty: hip dislocation. The nurse must clearly understand the key principles of postoperative hip protection and instruct the patient and family to follow them together, in order to ensure the success of the surgery and the safety of the patient.