快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究

Prospective study of the effect of fast track surery on peri-operative rehabilitation of elderly intertrochanteric fracture

目的比较快速外科通道（fast track surgery,FTS）理念和非FTS 理念指导下进行老年股骨转子间骨折围手术期康复的治疗效果.方法前瞻性收集天津骨科医院2013 年6 月至2014 年3 月确诊为老年股骨转子间骨折且符合纳入及排除标准的患者32 例,随机分为FTS 组（n=16）和非FTS 组（n=16）,FTS 组患者采用FTS 理念指导下的康复程序,非FTS 组采用围手术期常规康复程序,随访并比较两组患者术后的Harris 评分、患者满意度、疼痛视觉模拟评分（visual analoguescore,VAS）及住院天数,观察并发症的发生情况.结果32 例患者均获得随访,随访时间9 ～ 17 个月,平均（12.0±2.4）个月.术前两组VAS 评分比较差异无统计学意义（P 〉 0.05）,术后2 周FTS 组明显低于非FTS 组,差异有统计学意义（t=1.390,P 〈 0.05）.术前两组Harris 评分比较差异无统计学意义（P 〉 0.05）,术后8 周FTS 组明显高于非FTS 组,差异有统计学意义（t=0.244,P 〈 0.05）.FTS 组患者的住院时间少于非FTS 组,差异具有统计学意义（t=0.833,P 〈 0.05）.FTS 组患者的满意度评分高于非FTS 组,差异具有统计学意义（t=2.855,P 〈 0.05）.非FTS 组有2 例术后发生下肢深静脉血栓,1 例发生浅表组织感染,两组患者各有1 例患者术后出现肾衰竭,经治疗好转.结论老年股骨转子间骨折采用FTS 理念可以加速患者的康复,减轻患者疼痛,提高患者满意度及康复治疗效果.

ObjectiveTo compare the efficacy of peri-operative rehabilitation between thefast track surgery （FTS） and non-FTS with elderly intertrochanteric fractures. Methods32 patients withelderly intertrochanteric fractures in the Tianjin orthopaedic hospital during June 2013 to March 2014 werecollected. All patients were divided into FTS group （n=16） and non-FTS group （n=16） randomly, FTSgroup was treated with FTS and the non-FTS group was under routine perioperative rehabilitation program.Comparison were performed between two groups on postoperative by Harris score, patient satisfaction,visual analogue score （VAS）, length of stay （LOS） and postoperative complication. Results32 patientswere followed-up for 9-17 months, with an average of （12.0±2.4） months. There was no statisticallysignificant difference in preoperative VAS score between the two groups （P〉0.05）. And 2 weeks aftersurgery, VAS of FTS group was obviously lower than the non-FTS group, the difference was statisticallysignificant （t=1.390, P〈0.05）. There was no statistically significant difference in preoperative Harris scorebetween the two groups （P〉0.05）, while difference of Harris score between two groups were significantafter 8 weeks （t=0.244, P〈0.05）. Length of stay of FTS group was less than that of the non-FTS group,there was statistically significant difference （t=0.833, P〈0.05）. Satisfaction scores of FTS group werehigher than non-FTS group, the difference was statistically significant （t=2.855, P〈0.05）. In FTS group, 2cases had postoperative deep vein thrombosis of lower limb, 1 case had superficial tissue infection, bothgroups had 1 case of postoperative renal failure, and got relieved after treatment. ConclusionFTS caneffectively promote the rehabilitation process, reduce the pain and improve patient satisfaction in elderlyintertrochanteric fractures.