骨科加速康复手术切口操作与并发症防治专家共识

Expert consensus on surgical incision operation and prevention and treatment of complications in orthopaedics in enhanced recovery after surgery program

手术切口并发症是影响骨科加速康复、延长住院时间的重要因素,也是非计划二次手术的主要原因和手术部位感染的独立危险因素。为了规范骨科加速康复手术切口管理,减少切口并发症,提高医疗质量和安全,国家卫生健康委加速康复外科专家委员会骨科专家组、中国研究型医院学会骨科加速康复专业委员会、中国康复技术转化及促进会骨科加速康复专业委员会联合多学科专家成立骨科加速康复系列共识编写专家委员会,以临床问题为导向,遵循循证医学原则,归纳出6个方面的问题:(1)切口并发症危险因素的评估与控制措施;(2)手术切口的设计;(3)手术切口切开与显露的操作技术;(4)常见手术切口缝合的操作技术;(5)手术切口的术后管理;(6)常见手术切口并发症的诊断与治疗。按照上述6个方面的问题进行文献检索和归纳,结合2018版《中国骨科手术加速康复切口管理指南》及该指南推行近4年来存在的问题,并结合近年国内外最新研究进展,特别就骨科常见切口的缝合技术、术后管理及常见切口并发症的诊治进行了详细的阐述。经过反复讨论和修改后形成本共识,期望其为骨科加速康复切口操作与并发症防治的多学科协作起到积极的推动作用,最终达到加速患者康复的目的。

Surgical incision complications often bring barriers for enhanced recovery after surgery in orthopaedics and is a major factor for prolonged hospital stay,as well as the main cause of unplanned reoperation and an independent risk factor for surgical site infection.In order to standardize the management of surgery incision in ERAS program in orthopaedics,Orthopaedic Expert Group of ERAS profession Committee of National Health Commission,Orthopaedic ERAS profession Committee of Chinese Research Hospital Association,Orthopaedic ERAS profession Committee of China Association of Rehabilitation Technology Transformation and Promotion,together with experts from related disciplines,established a collaborative expert committee for this consensus writing.Focusing on the clinical problems and following evidence-based medicine principles,the experts summarized the following six aspects:(1)assessment and control of risk factors for surgical incision complications;(2)design of surgical incision;(3)surgical techniques for incision and exposure;(4)operation techniques of common surgical incision suture;(5)postoperative management measures of surgical incision;(6)diagnosis and treatment of common incision complications.Around these six aspects,literature was searched and induced,and the latest researches of recent years were referenced as well as the 2018 edition of A guideline on the management of incisions for the enhanced recovery after orthopaedic surgery in China and the problems as its executing for four years.Through repeated discussions and revisions,this consensus was developed hoping to promote the multidisciplinary cooperation and realize rapid recovery for patients.