加速康复外科理论在老年股骨颈骨折全髋关节置换术中的应用

Application of enhanced recovery after surgery in elderly patients with total hip arthroplasty

目的探讨加速康复外科理论在老年股骨颈骨折全髋关节置换术(THA)中的应用效果。方法将2012年12月至2015年12月湖北医药学院附属人民医院骨科收治的行THA并采取加速康复(ERAS)理念治疗的30例老年股骨颈骨折患者设为ERAS组,从同期行THA并采用传统康复治疗的老年股骨颈骨折患者中随机抽取30例设为传统组。于术后24 h、48 h、72 h对2组患者进行VAS评分并计算其评分优占比;于术前、术后2周、术后3个月、术后6个月对2组患者进行Harris评分。所有患者随访6个月。记录患者住院时间、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ERAS组术后24 h、48 h的VAS评分优占比更高,2组患者比较差异有统计学意义(P<0.05),但2组患者术后72 h的VAS评分优占比差异无统计学意义(P>0.05)。2组患者术后2周、术后3个月及术后6个月Harris评分较术前均有明显改善,差异有统计学意义(P<0.05)。2组患者术前Harris评分比较差异无统计学意义(P>0.05),术后2周、术后3个月、术后6个月ERAS组Harris评分较传统组更高,差异有统计学意义(P<0.05)。ERAS组并发症发生率为6.7%,明显低于传统组的26.7%,ERAS组患者住院时间(7.4±1.6)d明显短于传统组的(12.2±2.9)d,ERAS组满意度及遵医嘱情况高于传统组,2组患者上述指标比较差异有统计学意义(P<0.05)。结论行THA的高龄股骨颈骨折患者运用加速康复外科管理,可以减少患者住院时间,降低术后并发症发生率,提高患者满意度及生活质量。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)in elderly patients with total hip arthroplasty(THA).Methods A total of 30 elderly patients with femoral neck fractures who were admitted into Hubei Medical College from December 2012 to December 2015 were performed THA with ERAS(ERAS group),and other 30 elderly patients were performed traditional rehabilitation at the same period(traditional group).VAS scores were performed 24 h,48 h and 72 h after surgery in the two groups and the score ratio was calculated.Harris scores were calculated before the operation,as well as 2 weeks,3 months and 6 months after the operation.All the patients were followed up for 6 months.Hospital stay,complications at 6 months after operation,satisfaction at the last follow-up and compliance with medical advice were recorded.Results The VAS scores in ERAS group were higher 24 h and 48 h after surgery,and the difference between the two groups was statistically significant(P<0.05),but the difference was not statistically significant 72 h after surgery(P>0.05).The Harris scores of the two groups were significantly improved 2 weeks,3 months and 6 months after surgery compared with those before surgery,and the differences were statistically significant(P<0.05).There was no statistically significant difference in preoperative Harris scores between the two groups(P>0.05).And Harris scores of the ERAS group were higher in 2 weeks,3 months and 6 months after surgery compared with the traditional group,with statistically significant differences(P<0.05).The incidence of complications in ERAS group was 6.7%,which was significantly lower than 26.7%in the traditional group.The hospital stay in ERAS group was(7.4±1.6)day,which was significantly shorter than that(12.2±2.9)day in the traditional group.The satisfaction and compliance with medical advice in the ERAS group were higher than those in the traditional group,and the comparison of the above indexes between the two groups was statistically significant(P<0.05).Conclusion Enhanced recovery after surgery for elderly patients with femoral neck fractures can reduce the length of hospital stay and the incidence of postoperative complications,and it can improve the satisfaction and life quality of patients.