加速康复外科理念在老年全膝关节置换术围术期的应用

Application of enhanced recovery after surgery concept in the perioperative period of elderly total knee arthroplasty

目的探讨加速康复外科(ERAS)理念在老年人全膝关节置换围术期的应用。方法回顾性分析于宁夏医科大学总医院2018年8月~2019年8月因膝骨性关节炎行人工全膝关节置换术治疗的96例老年患者资料,将46例未运用ERAS的患者作为对照组,50例在围术期运用ERAS理念相关方法的患者作为试验组,所有患者资料均获得完整随访;观察两组患者手术时间、术中出血量、住院时间、术后并发症、膝关节特种外科医院(HSS)评分、视觉模拟量表(VAS)评分。结果两组手术时间、术中出血、切口愈合时间比较,差异均无统计学意义(P>0.05)。试验组住院时间短于对照组,术后1天、术后1周VAS评分及术后并发症总发生率低于对照组,术后1周、术后1个月及术后3个月HSS评分高于对照组,差异均有统计学意义(P<0.05)。结论ERAS在老年人全膝关节置换围术期的应用对手术时间、术中出血等术中疗效影响较小,但对术后关节康复效果影响显著,可加快术后膝关节活动度的恢复,减少术后并发症,提高膝关节功能,术后恢复更快,住院时间更短,能够使患者在围术期获得更大的临床疗效。

Objective To explore the application of enhanced recovery after surgery(ERAS)concept in the perioperative period of elderly total knee arthroplasty.Methods A retrospective analysis was proformed on 96 elderly patients who underwent artificial total knee arthroplasty for knee osteoarthritis from August 2018 to August 2019 in the General Hospital of Ningxia Medical University.The 46 patients who had not uesd ERAS were taken as in the control group,50 patients who used the ERAS concept-related method during in the perioperative period was taken as in the experimental group.All the patients′s data were completely followed up,the operation time,intraoperative blood loss,hospitalization time,postoperative complications,knee hospital for special surgery(HSS)score and visual analogue scale(VAS)score were observed in the two groups.Results There were no significant differences in the operation time,intraoperative bleeding,and incision healing time between the two groups(P>0.05).The hospitalization time in the experimental group was shorter than that in the control group,the VAS scores at 1 day and 1 week after surgery and the total incidence of postoperative complications were lower than those in the control group,the HSS scores at 1 week,1 month and 3 months after surgery were higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion The application of ERAS in the perioperative period of total knee arthroplasty in the elderly has little effect on the operation time,intraoperative bleeding and other therapeutic effects,but it has a significant impact on the postoperative joint rehabilitation effect,which can accelerate the recovery of postoperative knee joint mobility and reduce postoperative complications,improve knee joint function,faster postoperative recovery,shorter hospitalization time,and enable patients to achieve greater clinical efficacy during the perioperative period.