加速康复外科在前交叉韧带重建围术期的应用

Clinical application of enhanced recovery after surgery in the perioperative period of anterior cruciate ligament reconstruction

背景:膝关节前交叉韧带损伤的发病率近年来逐渐增高,其损伤后严重影响膝关节的运动功能,前交叉韧带重建术后康复锻炼也直接关系到患者能否获得理想的关节功能,将加速康复外科理念应用于膝关节镜下前交叉韧带重建术的围术期管理具有重要的临床意义。目的:探讨加速康复外科在前交叉韧带重建围术期的临床应用效果。方法:选取2016年7月至2018年7月武汉大学人民医院骨外科收治的前交叉韧带损伤患者60例,按照随机数字表法分为加速康复外科组和传统治疗组,每组30例,比较两组患者术后目测类比评分、膝关节活动度恢复时间、Lysholm膝关节评分、住院时间及患者住院满意度评分。该临床研究的实施符合《赫尔辛基宣言》和武汉大学人民医院对研究的相关伦理要求,参与患者均对试验过程完全知情同意。结果与结论:①加速康复外科组术后1,24 h及2,3,7 d的目测类比评分均显著低于传统治疗组(P<0.05);②加速康复外科组患者患侧膝关节术后活动度恢复到30°,60°,90°,120°所需的时间均显著小于传统治疗组(P<0.05);③加速康复外科组术后3个月及6个月膝关节Lysholm评分显著高于传统治疗组(P<0.05);④加速康复外科组平均住院时间显著短于传统治疗组(P<0.05);⑤加速康复外科组患者住院满意度评分显著高于传统治疗组(P<0.05);⑥结果表明,应用加速康复外科理念管理前交叉韧带重建围术期,较传统的围术期管理具有减轻患者焦虑、减轻术后疼痛、减少术后并发症、促进患者尽早康复、加速恢复肢体功能等多方面的优势。

BACKGROUND:Anterior cruciate ligament injury,with an increasing incidence in recent years,will seriously impact the motor function of the knee joint.Rehabilitation exercise after anterior cruciate ligament reconstruction is directly related to whether the patient can obtain ideal joint function.It is of important clinical significance to introduce the concept of enhanced recovery after surgery(ERAS)into the perioperative management of arthroscopic anterior cruciate ligament reconstruction.OBJECTIVE:To explore the clinical effect of ERAS in the perioperative period of anterior cruciate ligament reconstruction.METHODS:Sixty patients with anterior cruciate ligament injury,who were treated in the Department of Orthopedics,Renmin Hospital of Wuhan University from July 2016 to July 2018,were randomly divided into ERAS group(n=30)and traditional treatment group(n=30).Postoperative Visual Analogue Scale score,recovery time of knee range of motion,Lysholm knee scoring scale score,hospitalization duration,patients’satisfaction rating were compared between the two groups.The implementation of the study complied with the Declaration of Helsinki and the relevant ethical requirements of Wuhan University Renmin Hospital,and all the enrolled patients were fully informed of the trial process.RESULTS AND CONCLUSION:The Visual Analogue Scale scores in the ERAS group were significantly lower than those in the traditional treatment group at 1,24 hours,2,3,and 7 days after surgery(P<0.05).The time that the range of motion returned to 30°,60°,90°and 120°after surgery in the ERAS group was significantly less than that in the traditional treatment group(P<0.05).The Lysholm knee scoring scale scores in 3 months and 6 months after surgery in the ERAS group were significantly higher than those in the traditional treatment group(P<0.05).The length of hospitalization in the ERAS group was significantly lower than that in the traditional treatment group(P<0.05).The patients’satisfaction rating in the ERAS group was significantly higher than that in the traditional treatment group(P<0.05).To conclude,the introduction of ERAS concept into the perioperative management of anterior cruciate ligament reconstruction has obvious merits in reducing anxiety,relieving postoperative pain,reducing postoperative complications,promoting early recovery of patients and accelerating the recovery of knee joint function.