快速康复外科理念在全髋关节置换术围手术期的应用

Fast track surgery program used in the patients following total hip arthroplasty

目的 探讨在全髋关节置换患者中应用快速康复外科（FTS）的围手术期疗效。方法 自2012-07—2014-06诊治符合研究标准行关节置换的老年（年龄≥65岁）单侧髋部骨折81例,随机分为FTS组（应用快速康复外科理念）和常规组（应用传统方式）,比较2组中期临床疗效。结果 81例获得平均14.6（12-18）个月随访。所有患者切口均一期愈合,并术后2周拆线。FTS组术中出血量（t=3.05,P=0.003）、平均输血量（t=6.57,P〈0.001）均明显少于常规组,差异有统计学意义（P〈0.05）,2组手术时间（t=1.56,P=0.123）比较差异无统计学意义（P〉0.05）。FTS组术后住院（9.0±2.5）d,明显低于常规组（12.6±3.7）d,2组平均住院日（t=5.2,P〈0.001）比较差异有统计学意义（P〈0.05）。2组均未发生切口并发症。2组深静脉血栓（χ^2=0.44,P=0.507）、泌尿系统感染（χ^2=0.85,P=0.356）、其他（χ^2=0.07,P=0.792）并发症发生率比较,差异无统计学意义（P〉0.05）。通过对比术后出院当天、术后6个月和术后1年的髋关节Harris评分,可见FTS组的髋关节评分均优于常规组,2组比较差异有统计学意义（P〈0.05）。结论 FTS理论在高龄髋部骨折围手术期的应用,能明显缩短术后住院时间和住院费用,可以促进患者髋关节功能的康复,值得推广和应用。

Objective To study the clinical effect of fast track surgery（FTS） in the perioperative period for patients with total hip replacement. Methods From July 2012 to June 2014, 81 elderly patients（older than 65 years） following total hip arthroplasty were divided into FTS group（37 cases） and conventional therapy group（44 cases）. The clinical effects of two groups were compared. Results Eighty one cases were followed up for 14.6 months on an average（12-18 months）. One-stage incision healing was achieved in all patients, and the stitches were taken out two weeks after surgery. The operation bleeding amount（t =3.05,P =0.003） and volume of blood transfusion（t =6.57,P〈 0.001） in FTS group were significantly less than those of conventional therapy group（P〈0.05）. There was no significant difference in operative duration（t =1.56,P =0.123）between the two groups（P〉0.05）. The hospitalization duration（t =5.2,P〈 0.001） of FTS group was shorter than that of conventional therapy group（P〈0.05）, there was significant difference. No incision complication occurred. There were no significant differences in the rate of DVT, pneumonia, urethritis in two groups（P〉0.05）. There was significant difference in the hospital costs（t =2.75,P =0.007） between the two groups（P〈0.05）. By comparing Harris hip score at the day of discharge, 6 months and 1 year after surgery, FTS group was better than conventional therapy group, there was significant difference（P〈0.05）. Conclusion The perioperative application of fast track surgery in aged patients with hip fracture could shorten hospital stay and decrease the hospitalization cost. FTS could promote the functional recovery of hip joint, and is worth popularizing and applying.