加速康复外科理论在高龄股骨颈骨折THA中的应用

Application of accelerated rehabilitation surgery theory in THA of senile femoral neck fractures

目的探讨加速康复外科(ERAS)理论在高龄股骨颈骨折全髋关节置换术(THA)中的疗效。方法采用回顾性分析,选取2014年12月至2016年12月重庆市中医院收治的老年股骨颈骨折行THA且采取ERAS治疗的患者30例作为ERAS组,另从同期采用传统康复治疗的老年股骨颈骨折行THA病例中随机抽取30例作为传统组。分别于术前、术后2周及术后3、6个月对2组进行Harris评分。分别于术后24、48、72h对2组进行视觉模拟评分(VAS评分)并计算其评分优占比。记录2组患者住院时间、术后6个月并发症发生率、末次随访满意度及遵医嘱情况。结果所有患者均随访6个月。2组术后2周和术后3、6个月Harris评分较同组术前均有显著改善,差异均有统计学意义(P<0.05)。2组术前Harris评分比较差异无统计学意义(P>0.05),ERAS组术后2周和术后3、6个月Harris评分高于传统组,差异均有统计学意义(P<0.05)。ERAS组术后24、48h的VAS评分优占比高于传统组,差异均有统计学意义(P<0.05);2组术后72h的VAS评分优占比比较差异无统计学意义(P>0.05)。ERAS组并发症发生率为6.7%,显著低于传统组的26.7%,差异有统计学意义(P<0.05)。ERAS组住院时间短于传统组,差异有统计学意义(P<0.05)。ERAS组满意例数、遵医嘱例数均高于传统组。结论高龄股骨颈骨折行THA患者运用ERAS,可以减少患者住院时间,降低患者术后并发症发生率,提高患者满意度及依从性,提高患者生活质量。

Objective To investigate the efficacy of accelerated rehabilitation surgery theory (ERAS) in total hip arthroplasty (THA) in elderly patients with femoral neck fracture. Methods A retrospective analysis was used.Thirty patients with aged femoral neck fracture who underwent THA and received ERAS treatment from December 2014 to December 2016 in Chongqing Hospital of Traditional Chinese Medicine were selected as the ERAS group.In addition,30 patients with traditional femoral neck fractures who underwent conventional rehabilitation in the same period were randomly selected as the traditional group.Harris scores were performed on the two groups before surgery,2 weeks after surgery,3 months after surgery,and 6 months after surgery.Visual analog scales (VAS scores) were scored at 24,48,and 72 h after surgery,and their scores were calculated.The hospitalization time,the complication rate at the 6th month after surgery,the satisfaction of the last follow-up,and the doctor′s advice were recorded. Results All patients were followed up for 6 months.The Harris scores of the 2 groups were significantly improved after 2 weeks,3 months and 6 months after operation,and the differences were statistically significant ( P <0.05).There was no significant difference in the preoperative Harris score between the two groups ( P >0.05).The Harris score was higher in the ERAS group than in the conventional group at 2 weeks,3 months after surgery,and 6 months after surgery ( P <0.05).The VAS scores of the ERAS group at 24 and 48 h after surgery were higher than those of the traditional group,and the difference was statistically significant ( P <0.05).There was no significant difference in the ratio of VAS scores between the two groups at 72 h after surgery ( P >0.05).The complication rate in the ERAS group was 6.7%,which was significantly lower than that in the traditional group ( 26.7 %).The difference was statistically significant ( P <0.05).The hospital stay in the ERAS group was shorter than the traditional group,and the difference was statistically significant ( P <0.05).The number of satisfactory cases in the ERAS group was higher than that in the traditional group. Conclusion The use of ERAS in patients with THA in femoral neck fractures can reduce the length of hospital stay,reduce the incidence of postoperative complications,improve patient satisfaction and compliance,and improve the quality of life of patients.