加速康复外科理念在胸腰椎骨折手术中的应用效果

Application effect of enhanced recovery after surgery concept in thoracolumbar fracture surgery

目的评价加速康复外科(ERAS)理念在胸腰椎骨折手术中的应用效果。方法回顾性分析2016年1月至2018年12月收治的75例胸腰椎骨折手术患者的临床资料,其中40例将ERAS理念应用于手术治疗中的患者被设为加速康复组,35例常规手术治疗的患者被设为常规组,比较两组的治疗效果。结果所有患者随访12~18个月,平均(15.23±2.53)个月。加速康复组的失血量、术后住院天数少于常规组,离床活动时间早于常规组(P<0.05);术后12月随访,常规组出现2例断钉,2例螺钉松动拔出,加速康复组内固定并发症发生率低于常规组(P<0.05);术后1 d、7 d、30 d、3个月,加速康复组的VAS评分低于常规组(P<0.05);术后12个月,加速康复组的伤椎Cobb角小于常规组,伤椎椎体前缘高度压缩率低于常规组(P<0.05)。结论ERAS理念运用于胸腰椎骨折手术中能够促进患者早期康复,减少内固定并发症的发生。

Objective To evaluate the application effect of enhanced recovery after surgery(ERAS)concept in thoracolumbar fracture surgery.Methods The clinical data of 75 patients with thoracolumbar fracture treated from January 2016 to December 2018 were analyzed retrospectively,40 patients who applied ERAS concept to surgical treatment were set as accelerated rehabilitation group,35 patients treated with conventional operation were set as conventional group,and the therapeutic effect of the two groups was compared.Results All patients were followed up for 12-18 months,with an average of(15.23±2.53)months.The blood loss volume and postoperative hospitalization days of the accelerated rehabilitation group were less than those of the conventional group,and the time to get out of bed was earlier than that of the conventional group(P<0.05);follow-up at 12 months after the surgery,there was broken screw in 2 cases and the screw was loose and pulled out in 2 cases in the conventional group,the incidence of internal fixation complications in the accelerated rehabilitation group was lower than that in the conventional group(P<0.05);at 1 d,7 d,30 d,and 3 months after the surgery,the VAS score of the accelerated rehabilitation group was lower than that of the conventional group(P<0.05);at 12 months after the surgery,the Cobb angle of the injured vertebra in the accelerated rehabilitation group was smaller than that in the conventional group,and the compression rate of the anterior edge of the injured vertebral body was lower than that in the conventional group(P<0.05).Conclusion The application of ERAS concept in thoracolumbar fracture surgery can promote early recovery of patients and reduce the occurrence of complications of internal fixation.