加速康复外科在关节镜下微创治疗胫骨平台骨折患者效果评价

The clinical effect of enhanced recovery after surgery to tibial plateau fractures patients applied arthroscopic minimally invasive treatment

目的探讨和分析加速康复外科在关节镜下微创治疗胫骨平台骨折患者的临床应用效果。方法选择2016年1月至2017年7月在上海市静安区闸北中心医院骨科收治且行关节镜下微创治疗胫骨平台骨折患者60例，按患者住院ID号后2位数字参照随机数字表法将其分为对照组及观察组各30例。对照组采用常规围手术期策略，观察组依托多学科合作加速康复外科理念，通过术前评估与宣教、营养与禁食、超前预康复及预防性镇痛；术中优化麻醉方式、体液管理及体温控制；术后营养支持、多模式镇痛及早期下床活动与康复锻炼，实施规范化、专业化的围手术期全程优化管理。比较2组患者术后视觉模拟评分法（VAS）评分、首次下床活动时间、主动屈膝120。天数、生活自理能力及美国膝关节协会（AKSS）评分的差异。结果观察组术后6、12、24h及出院时VAS评分分别为（4．48±1．18）、（3．81±1．68）、（3．05±1．63）、（2．65±1．65）分，对照组分别为（5．45±1．15）、（4．15±1．05）、（3．71±1．15）、（3．23±1．68）分，2组比较差异有统计学意义（t=0．796～0．902，均P〈0．05）；观察组术后首次下床活动时间、主动屈膝1200天数、出院时生活自理能力及术后1个月膝关节评分、功能评分分别为（5．61±1．40）h、（4．01±1．10）d、（80．22±3．60）分、（71．89±6．56）分、（64．13±6．15）分，对照组分别为（35．8±8．10）h、（6．82±1．60）d、（64．25±3．80）分、（63．45±8．36）分、（60．95±8．98）分，2组比较差异有统计学意义（t=2．789-10．200，均P〈0．05）。结论加速康复外科应用于关节镜下微创治疗胫骨平台骨折患者可有效减轻患者术后疼痛，加快患者术后康复，值得推广。

Objective To explore and analyze the clinical effect of enhanced recovery after surgery to tibial plateau fractures patients applied arthroscopic minimally invasive treatment. Methods A total of 60 tibial plateau fractures patients were selected in our orthopedics department from January 2016 to July 2017 and who applied arthroscopic minimally invasive treatment, according to the last two-digit number of patient ID, divided them into observation group （n=30） and control group （n=30） randomly. The control group used regular perioperative strategies. The observation group used multidisciplinary cooperation fast track surgery idea, through preoperative assessment and education, nutrition and fasting, advance pre-rehabilitation and preventive analgesia; intraoperative optimization of anesthesia, body fluid management and body temperature control; postoperative nutritional support, multimodal analgesia, early ambulation and rehabilitation exercises, implied standardized and professional perioperative overall optimization management. The differences of the condition of 6 h, 12 h, 24 h after surgery, VAS score on discharge, time of first ambulation, active knee flexion 120° days; self-care ability at discharge and AKSS score one month after surgery between 2 groups were compared. Results The VAS scores 6 h, 12 h, 24 h after surgery and at discharge were 4.48±1.18, 3.81±1.68, 3.05±1.63, 2.65±1.65 in the observation group, and were 5.45 ± 1.15, 4.15 ± 1.05, 3.71 ± 1.15, 3.23 ± 1.68 in the control group. The differences were statistically significant （t= 0.796-0.902 , P〈0.05）. The time of first ambulation, active knee flexion 120°days, self-care ability at discharge and AKSS scores one month after surgery were （5.61±1.4） hours, （4.01± 1.1） days, 80.22±3.6, 71.89±6.56 and 64.13±6.15 in the observation group, and （35.8±8.1） hours, （6.82±1.6） days, 64.25±3.8, 63.45±8.36 and 60.95±8.98 in the control group. The differences were statistically significant （t=2.789~10.200, P〈0.05）. Conclusion Enhanced recovery after surgery to tibial plateau fractures patients applied arthroseopic minimally invasive treatment is worthy of being popularized as it＇ s beneficial to tibial plateau fractures patients. It can also fasten recovery and improve quality of life for postoperative patients.