加速康复外科是现代骨外科发展的趋势

Enhanced recovery after surgery( ERAS ): the trend of modern orthopedic surgery

近年来,国内外骨外科快速发展,各种新技术、新材料和新器械不断推出,医疗技术水平提高很快。然而,医务人员常常首先关心的是手术本身,对手术方法的新进展易于引起医生的兴趣,对患者的围术期管理则常按传统方法进行,使围术期管理措施改进缓慢,术后少数患者易于出现并发症或并存疾病复发或加重,致使手术后效果欠佳。

The concept of enhanced recovery after surgery （ ERAS ） was introduced by Professor Kehlet in 1997, and the core idea of ERAS is to reduce perioperative stress, complications and shorten hospital stay. At present, ERAS has been successfully applied in many fields including orthopedics, and the successful implementation needs multi-discipline cooperation with the same goal. The main contents include health education, preoperative risk assessment, blood management, pain management, et al. Evidence has confirmed the efficacy and safety of ERAS in total hip / knee arthroplasty in terms of decreasing hospital stay and complications. Although significant progress has been made, little is known in fields of spine and trauma. Research on pathophysiological mechanism of stress reaction and complications can provide clues for better optimization of perioperative management, while challenge of ideas and thinking. Multidisciplinary treatment can provide a guarantee for the implementation of ERAS.