ERAS理念在关节镜下重建前交叉韧带围术期康复的临床研究

Clinical study of ERAS concept used in rehabilitation training of ACL reconstruction under arthroscope

目的:应用ERAS理念指导关节镜下重建前交叉韧带患者的围术期患者康复训练并研究其临床疗效.方法:选取60例关节镜下重建前交叉韧带术后患者,随机分为ERAS观察组和对照组.ERAS观察组在常规康复的基础上加强前交叉韧带重建术后围术期内医疗、护理、康复为一体的多模式小组管理,于术前进行预防性镇痛、心理认知康复、康复指导及训练.分别于术后2周、4周、6周、8周、6个月对2组患者在治疗前后疼痛、关节活动、、膝关节功能(Lysholm)、脱拐时间进行评估.结果:2组患者术前VAS评分无显著差异(P>0.05),ERAS观察组患者术后疼痛水平明显低于对照组(P<0.05).2组患者入院时膝关节评分(Lysholm)比较差异无统计学意义(P>0.05).经过6个月的康复治疗后,ERAS观察组患者术后Lysholm膝关节评分优于对照组(P<0.05);2组患者的AROM评分在术前无显著差异(P>0.05),而术后ERAS观察组患者的整体评分显著优于对照组,(P<0.05);脱拐时间比较ERAS观察组平均37天,对照组平均68天,ERAS观察组脱拐时间明显早于对照组(P<0.05).结论:基于ERAS理念结合康复训练在关节镜下重建前交叉术后恢复中有助于缓解疼痛、促进早期功能康复,从而提高前交叉韧带术后患者快速、无痛的整体功能恢复,达到临床治愈的最高境界.

Objective:To perform rehabilitation training with ERAS concept after ACL reconstruction under arthroscope and study its clinical efficacy.Methods:60 patients with ACL reconstructed under arthroscope were enrolled and divided into ERAS treated group and control group randomly.Both groups received regular rehabilitation training,and the ERAS group received preoperative analgesia and rehabilitation of psychological cognition additionally according to the ERAS concept.Pain (VAS scoring),range of joint motion (AROM scoring) and joint function (Lysholm scoring) were assessed before surgery and at 2 weeks,4 weeks,6 weeks,8 weeks and 6 months after surgery.The time point of independent walking were noted.Statistical assessments were performed.Results:Before surgery,both groups perceived similar level of pain (p>0.05).At the same tim e,there was no difference of either AROM nor lysholm scoring detected in the two groups (p>0.05).After surgery,the pain perceived of both groups alleviated,the pain level of the ERAS group was significantly lower than the control group (p<0.05).The AROM and Lysholm scoring improved more in the ERAS group after surgery compared with the control group (p<0.05).The average time of independent waling of the ERAS groups was 37 days which was significantly shorter than the control group (68 days)(p<0.05).Conclusion:Patients treated with ERAS concept achieved better pain alleviation,faster joint function recovery and satisfied clinical efficacy.