加速康复外科理念在双反牵引微创治疗胫骨平台骨折中的应用研究

Application of ERAS concept in treatment of tibial plateau fractures with minimally invasive double reverse tractions

目的探讨加速康复外科(ERAS)理念在双反牵引微创治疗的胫骨平台骨折患者围术期中的应用。方法回顾性研究分析2018年2月至2020年6月华中科技大学同济医学院附属协和医院骨科收治的39例胫骨平台骨折患者资料,男20例,女19例;年龄27~47岁。所有患者均采用双反牵引微创治疗,根据围术期管理方案不同将患者分为对照组(接受常规围术期处理,20例)和ERAS组(接受ERAS方案处理,19例)。比较两组患者的术后24 h疼痛视觉模拟评分(VAS)、引流量、引流管拔除时间、住院时间、患者满意度、并发症的发生情况,以及出院时、术后1、3、6、9个月美国特种外科医院(HSS)评分。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者均获完整随访,时间7~15个月(平均10.9个月)。两组患者的引流量、引流管移除时间、出院时和术后1个月的HSS评分比较差异均无统计学意义(P>0.05)。ERAS组患者术后24 h VAS评分、住院时间[(9.4±4.8)d]、患者满意度、术后3、6、9个月ERAS组患者的HSS评分[(90.8±3.8)分、(93.5±4.3)分、(95.6±3.7)分]显著优于对照组[(13.3±1.9)d、(87.5±5.1)分、(88.1±4.4)分、(88.8±4.4)分],差异均有统计学意义(P<0.05)。所有患者术后均未出现伤口感染、内固定断裂或失效、骨折不愈合等严重并发症。结论采用ERAS理念制订围术期治疗方案有利于提高双反牵引微创治疗胫骨平台骨折的疗效,提高患者的满意度。

Objective To evaluate the application of ERAS concept in the treatment of tibial plateau fractures with minimally invasive double reverse tractions(MIDRT).Methods A retrospective study was conducted of the 39 patients with tibial plateau fracture who had been treated at Department of Orthopedics,Union Hospital from February 2018 to June 2020.They were 20 males and 19 females,aged from 27 to 47 years.All cases were treated with the same MIDRT but with different perioperative management protocols.Of them,20 received conventional perioperative management(control group)and 19 perioperative ERAS management(ERAS group).The 2 groups was compared in terms of visual analogue scale(VAS)at 24 hours postoperation,drainage volume,time for removal of drainage tube,hospital stay,patient’s satisfaction,incidence of complications,and American Special Surgery Hospital(HSS)scores at discharge and 1,3,6 and 9 months postoperation.Results There was no significant difference in the preoperative general data between the 2 groups,showing comparability between groups(P>0.05).All cases obtained complete follow-up(mean,10.9 months).No statistically significant difference was found between the 2 groups in drainage volume,time for removal of drainage tube or HSS scores at discharge or one month after discharge(P>0.05).The VAS score at 24 hours after operation,hospital stay[(9.4±4.8)d],patient's satisfaction,HSS scores[(90.8±3.8),(93.5±4.3)and(95.6±3.7)]in the ERAS group were significantly better than those in the control group[(13.3±1.9)d,(87.5±5.1),(88.1±4.4)and(88.8±4.4)](P<0.05).None of the patients had such serious complications as wound infection,breakage or failure of internal fixation,or fracture nonunion.Conclusion The perioperative management protocols designed according to the ERAS concept may enhance the clinical efficacy of MIDRT in the treatment of tibial plateau fractures and thus raise the patient’s satisfaction.