加速康复外科理论在高龄股骨颈骨折围手术期的初步应用

Initial application of fast-track surgery during the perioperative period for the elderly of femoral neck fracture

[目的]探讨加速康复外科理论在高龄股骨颈骨折患者围手术期应用的临床效果。[方法]参考患者意愿,将自2010年7月～2012年3月份收治符合研究标准拟行关节置换的高龄(年龄≥75岁)股骨颈骨折患者133例,分为A组(加速康复外科组)64人和B组(常规处理组)69人。围手术期分别应用快速康复理论和常规处理方法进行围手术期处理。对比分析两组患者围手术期并发症情况及术后住院时间,并对两组患者进行随访,对比两组患者近期临床效果。[结果]术中出现假体周围骨折3例,围手术期死亡3例,快速康复组术后住院时间(7.0±2.0)d,明显低于普通处理组(9.6±2.9)d(P=0.000),快速康复组围手术期中枢神经系统疾病并发症发生率及恶心、呕吐发生率明显低于普通处理组(P=0.01,P=0.007)。平均随访12.9个月(4.1～24.3个月),随访率为90.6%,两组患者关节功能评分及并发症发生率无明显差异。[结论]快速康复外科理论在高龄股骨颈骨折围手术期的应用,能明显缩短术后住院时间并减少并发症,可以促进患者的快速康复。

[ Objective ] To discuss the clinical effects of the application of fast track surgery during the perioperative period in the elderly who have femoral neck fracture. [ Method I From July 2010 to March 2012,133 selected elderly patients （ age ≥ 75 years） with femoral neck fracture, underwent either accelerated perioperative procedure or standard procedure （ n = 64, n = 69, respectively）. Outcome were assessed on the perioperative complications and postoperative hospital stay, and the short-term clin- ical effects of the two groups were compared. [ Result ] Intraoperative periprosthctic fracture occurred in 3 cases, perioperative death occurred in 3 cases. The mean postoperative hospital stay of fast-track surgery group （7.0 ± 2. 0 days） was significantly lower than that of the standard group （9. 6 ± 2. 9 days） （ P = 0. 000）. Perioperative complication rates of central nervous system diseases and incidence of nausea and vomiting were significantly lower than standard group. （ P = 0.01, p = 0. 007 respectively）. The average follow-up period was 12. 9 months （4. 1 -24. 3 months） ,the follow-up rate was 90. 6%. There was no significant difference in joint function score and the rates of complications between the two groups during the follow-up period. [ Conclusion ] The application of the fast track surgery in the elderly with femoral neck fracture, can significantly shorten postop- erative hospital stay and reduce the rates of complications, thus accelerating the rehabilitation of patients.