加速康复联合微创经皮锁定钢板内固定治疗肱骨近端骨折的疗效分析

Efficacy analysis of enhanced recovery after surgery combined with minimally invasive percutaneous plate osteosynthesis in the treatment of proximal humeral fracture

【目的】探讨加速康复(enhanced recovery after surgery,ERAS)联合微创经皮锁定钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)在治疗肱骨近端骨折中的作用。【方法】32例肱骨近端骨折的患者,随机分为ERAS联合MIPPO组和单纯MIPPO组,每组16例。ERAS联合MIPPO组和单纯MIPPO组手术方式一致,但二者在术前术后处理方式不同,比较两组之间术后VAS评分、并发症发生率、平均住院日、平均住院花费、术后下地时间、术后开始功能锻炼时间。【结果】ERAS联合MIPPO组和单纯MIPPO组相比,在术后VAS评分、恶心呕吐发生率12.5%vs. 43.75%、平均住院日(5.7±1.3)d vs.(8.2±1.4)d、平均住院花费(3.1±0.8)万元vs.(3.9±0.6)万元、患者术后下地时间(6.2±0.8)h vs.(24.2±2.7)h、术后开始功能锻炼时间(2.1±0.4)d vs.(7.2±1.2)d等方面差异有统计学意义(P<0.05)。【结论】ERAS联合MIPPO有利于患者术后康复,可以减轻术后疼痛,减少手术并发症,缩短平均住院日,降低平均住院花费,加快术后下地和功能锻炼,值得临床推广应用。

【Objective】To explore the effect of enhanced recovery after surgery(ERAS)combined with minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of proximal humeral fracture.【Methods】A total of 32 patients with proximal humeral fracture were randomly divided into ERAS combined with MIPPO group and MIPPO group,16 cases per group.The operation mode was the same in both groups,while the treatment mode before and after the operation was different.The VAS score,the incidence of complications,the average hospitalization days and cost,the postoperative time of beginning to walk and functional exercise were compared between the two groups.【Results】Compared with MIPPO group,the VAS score in the ERAS combined with MIPPO group was lower.The incidence of nausea and vomiting was 12.5%vs.43.75%.The average hospitalization days were(5.7±1.3)d vs.(8.2±1.4)d,and the average hospitalization cost was(3.1±0.8)w vs.(3.9±0.6)w.The time of beginning to walk postoperatively was(6.2±0.8)h vs.(24.2±2.7)h while the time of beginning functional exercise after operation was(2.1±0.4)d vs.(7.2±1.2)d(P<0.05).【Conclusion】ERAS combined with MIPPO can alleviate the postoperative pain,reduce postoperative complications,shorten average hospitalization days and cost,bring forward days of walking and functional exercise,which is better for patients'recovery and is worthy for clinical application.