加速康复外科理念在军事训练伤致前交叉韧带断裂围术期临床应用

Enhanced recovery after surgery in perioperative period of knee anterior cruciate ligament reconstruction

目的探讨在军事训练伤致前交叉韧带断裂围术期应用加速康复（ERAS）外科理念的临床效果。方法选取58例军事训练伤致前交叉韧带断裂需行韧带重建患者,按围术期处理方法的不同分为加速康复组和传统康复组,每组29例。比较两组患者术后不同时间疼痛的程度、并发症、活动量、膝关节Lysholm评分、膝关节活动度恢复时间及住院时间的差异。结果加速康复组术后1、24、48 h和3~7 d的疼痛视觉模拟评分分别为（1.65±0.94）分、（2.41±1.45）分、（2.09±0.80）分、（1.35±0.73）分,明显低于传统康复组的（6.83±1.02）分、（6.87±1.95）分、（6.39±0.70）分、（5.69±0.63）分,差异均有统计学意义（P〈0.05）。与传统康复组相比,加速康复组术后并发症发生率降低、活动量增加、膝关节Lysholm评分增高、膝关节活动度恢复时间及住院时间明显缩短,差异均有统计学意义（P〈0.05）。结论 ERAS理念在军事训练伤致前交叉韧带断裂围术期中的应用是安全可行的,可以有效地减少并发症的发生、提高患者的术后生存质量、促进膝关节功能恢复、缩短住院时间。

Objective To explore the efficacy of enhanced recovery after surgery（ ERAS） in the perioperative period of anterior cruciate ligament（ ACL） reconstruction in the patients with military training injuries. Methods A retrospective study was performed on 58 patients underwent ligament reconstruction. According to the different perioperative management methods,patients were divided into the enhanced recovery group（ n = 29） and the conventional recovery group（ n = 29）. The degree of pain,complications,activity amount,knee Lysholm score,ROM recovery time and hospitalization time were compared between the two groups. Results The VAS scores in the enhanced recovery group after 1 hour,24 hours,48 hours and 3-7 days were（ 1. 65 ± 0. 94）,（ 2. 41 ± 1. 45）,（ 2. 09 ± 0. 80） and（ 1. 35 ± 0. 73）,respectively,which were significantly lower than those in the conventional recovery group（ 6. 83 ± 1. 02）,（ 6. 87 ±1. 95）,（ 6. 39 ± 0. 70） and（ 5. 69 ± 0. 63）,respectively,the differences were statistically significant（ P〈0. 05）. Compared with the conventional recovery group,the rate of postoperative complications were less,the activity amount and the knee Lysholm score were increased,the recovery time of ROM and the length of hospitalization were shortened,the differences were statistically significant（ P〈0. 05）. Conclusion ERAS concept in the perioperative period of anterior cruciate ligament rupture caused by military training injury is safe and feasible,which can effectively reduce the incidence of complications,improve the postoperative quality of life,promote the recovery of knee function and shorten the hospitalization time.