加速康复外科联合标准化康复路径在全髋关节置换术治疗老年股骨颈骨折患者中的应用

Efficacy of fast-track surgery combined with standard rehabilitation training in elderly patients after total hip arthroplasty

目的探讨加速康复外科（FFS）联合美国特种外科医院（HSS）标准化康复训练在全髋关节置换术（THA）治疗老年股骨颈骨折患者中的应用效果。方法回顾性分析2013年12月至2014年12月期间行THA的90例老年股骨颈骨折患者资料，根据干预方式不同分为试验组和对照组（n=45），试验组：男23例，女22例，平均年龄为（68．2±3．7）岁；对照组：男22例，女23例；平均年龄为（70．6±4．1）岁。对照组实施常规护理和HSS标准化康复训练，试验组实施FTS联合HSS标准化康复训练。分别于术前和术后4、8和14周进行髋关节Harris评分、疼痛视觉模拟评分（VAS），记录两组患者术后14周并发症的发生率。结果所有患者均完成14周随访。试验组与对照组患者术前髋关节Harris评分和VAS评分比较差异均无统计学意义（P〉0．05）。术后4、8和14周，试验组患者髋关节Harris评分[（67．2±3．5）、（88．3±2．5）、（92．5±3．3）分]均显著高于对照组患者[（52．5±7．8）、（65．8±4．9）、（72．2±4．9）分]，VAS评分[（3．4±0．8）、（2．2±0．8）、（1．3±0．5）分]显著低于对照组患者[（5．6±0．9）、（4．2±0．8）、（2．9±0．8）分]，差异均有统计学意义（P〈0．05）。试验组无一例患者发生并发症，对照组14例（31．1％）患者发生并发症，两组比较差异有统计学意义（P〈0．05）。结论THA治疗老年股骨颈骨折患者中运用FTS联合HSS标准化康复训练，能够有效地减少并发症的发生，使患者髋关节功能快速恢复。

Objective To explore the efficacy of fast-track surgery （FrS） combined with standard rehabilitation program （HSS） in elderly patients undergoing total hip arthroplasty （THA） . Methods Ninety elderly patients with femoral neck fracture were randomly assigned to receive either FTS plus HSS rehabilitation program （experimental group, n = 45） or HSS rehabilitation program （control group, n = 45） after THA from December 2013 to December 2014 in our hospital. The experimental group had 23 men and 22 women, with an average age of 68.2 ± 3.7 years. The control group had 22 men and 23 women, with an average age of 70. 6 ± 4. 1 years. Harris score and visual analogue scale （VAS） were used to assess the hip joint function before operation, 4, 8 and 14 weeks after operation. The complications were compared between the 2 groups at 14 weeks after operation. Results All the patients completed a 14-week follow-up. There were no significant differences in Harris and VAS scores at pre-operation between the 2 groups （ P 〉 0. 05）. At 4, 8 and 14 weeks after operation, the Harris scores in the experimental group （67.2 ± 3.5, 88.3 ± 2. 5 and 92.5 ± 3.3） were significantly higher than those in the control group （52.5 ± 7.8, 65.8 ± 4.9 and 72.2±4.9） and the VAS scores in the experimental group （3.4±0.8, 2.2±0.8 and 1.3±0.5） were significantly lower than those in the control group （5.6 ±0. 9, 4. 2 ±0. 8 and 2.9 ±0. 8） （ P 〉 0. 05）. There were no complications in the experiment group while there were 14 complications （31.1% ） in the control group, showing a significant difference （ P 〈 0. 05） . Conclusion FTS combined with HSS standardized rehabilitation can effectively reduce the incidence of complications and accelerate the functional recovery of hip joint in elderly patients after THA.