快速康复外科在老年股骨转子间骨折围术期的运用效果

Value of enhanced recovery after surgery in elderly patients with intertrochanteric fractures during perioperative period

目的探讨加速康复外科（ERAS）在老年股骨转子间骨折患者围术期的应用效果。方法采用回顾性病例对照研究分析2016年7月-2017年8月上海交通大学附属仁济医院嘉定分院收治的72例老年单侧新鲜股骨转子间骨折患者临床资料，根据治疗方法不同分为ERAS组和常规组。其中ERAS组35例，男15例，女20例；年龄65-92岁，平均78．6岁。左侧19例，右侧16例。致伤原因扭伤25例，摔伤10例。按Evans分型：1型4例，2型10例，3型12例，4型9例。合并内科慢性疾病17例。常规组37例，男18例，女19例；年龄65—96岁，平均77．6岁。左侧21例，右侧16例。致伤原因：扭伤26例，摔伤11例。按Evans分型：1型4例，2型11例，3型13例，4型9例。合并内科慢性疾病18例。常规组按照传统模式处理，ERAS组在传统模式基础上增加ERAS术前、术中和术后相关措施。记录两组手术时间、术中出血量、输血量、术后住院时间、ERAS术后并发症发生率、术后髋关节功能Harris评分。 结果患者均获随访12-18个月，平均14．8个月。患者切口均I期愈合。ERAS组手术时间[（40．4±10．7）min]、术中出血量[（202．1±57．0）m1]、输血量[（0．82±0．20）U]、术后住院时间[（6．1±0．8）d]均明显低于常规组[（50．5±12．4）min、（260．3±75．2）ml、（1．23±0．34）u、（12．6±0．4）d]（P〈0．05或0．01）。常规组并发症发生率为32％（12／37），ERAS组并发症发生率为9％（3／35）（P〈0．05）。ERAS组末次随访时髋关节功能Harris评分[（95．3±0．9）分]优于常规组[（86．9±0．7）分]（P〈0．01）。结论ERAS理念在老年股骨转子问骨折围术期的应用，能明显减少术中出血量和输血量，缩短手术时间和术后住院时间，降低术后并发症发生率，并促进患者髋关节功能的恢复。

Objective To explore the application effect of enhanced recovery after surgery （ERAS） on elderly patients with intertrochanteric fractures during perioperative period. Methods Seventy-two elderly patients with unilateral fresh femoral intertrochanteric fractures admitted from July 2016 to August 2017 were selected. The patients were divided into ERAS group and regular group according to the treatment approach. In the ERAS group （n =35）, there were 15 males and 20 females, aged 65-92 years （mean, 78.6 years）, with 19 patients on the left side and 16 on the right side. The injury causes included sprain in 25 patients and fall from height in 10. According to Evans classification, there were 4 patients with type 1, 10 with type 2, 12 with type 3 and 9 with type 4 in the ERAS group. Seventeen patients in the ERAS group （49%） had internal chronic diseases. In the regular group （n = 37 ）, there were 18 males and 19 females, aged 65-96 years （mean, 77.6 years）, with 21 patients on the left side and 16 on the right side. The injury causes included sprain in 26 patients and fall from height in 11. According to Evans classification, there were 4 patients with type 1, 11 with type 2, 13 with type 3, and 9 with type 4. Eighteen patients （49%） in the regular group had internal chronic diseases. The regular group adopted the conventional approach, while the ERAS group additionally adopted the concept of ERAS. The intraoperative blood loss, average blood transfusion volume, operation time, postoperative hospital stay, postoperative complication incidence, and postoperative hip function Hart＇is score of the two groups were recorded. Results All patients were followed up for an average of 14.8 months （range, 12-18 months）. The patients acquired primary healing. The operation time was （40.4 ± 10.7）minutes, intraoperative blood loss （ 202.1 ± 57.0 ） ml, blood transfusion volume （ 0. 82 ± 0.20） U and postoperative hospitalization time （6.1 ±0.8）days in ERAS group, which showed significant difference in comparison with regular group, with operation time, intraoperative blood loss, blood transfusion volume and postoperative hospitalization time for （50.5 ± 12.4） minutes, （260.3 ± 75.2） ml, （ 1.23 ± 0.34） U and （ 12. 6 ± 0.4） days respectively （P 〈0.05 or 0.01 ）. The incidence of complications was 32% （ 12/37 ） in the regular group, and was 9% （3/35） in ERAS group （ P 〈 0.05）. Harris score of hip joint function was （95.3 ± 0. 9） points in ERAS group and （ 86.9 ± 0.7 ） points in regular group （ P 〈 0.05 ）. Conclusions For elderly patients with intertrochanteric fractures during the perioperative period, application of ERAS can obviously reduce intraoperative blood loss and average blood transfusion, shorten the operation time and postoperative hospital stay, reduce the incidence of postoperative complications, and promote the rehabilitation of the hip function of the patients.