直接前方入路结合加速康复外科对高龄患者人工髋关节置换术后康复效果的影响

Effect of direct anterior approach combined with accelerated rehabilitation surgery on rehabilitation of elderly patients after total hip arthroplasty

目的探究直接前方入路结合加速康复外科(ERAS)对高龄患者人工髋关节置换术后康复效果的影响。方法回顾性分析2018年1月至2020年1月柳州市工人医院进行人工髋关节置换术的高龄患者97例,按不同的手术方法分为对照组(n=50)和观察组(n=47)。2组均进行加速康复外科干预,对照组采用外侧入路全髋关节置换术,观察组采用直接前方入路全髋关节置换术。对比2组手术一般情况、血清应激指标[血清肌酸激酶(CK)、C反应蛋白(CRP)、红细胞沉降率(ESR)]水平、视觉疼痛模拟评分(VAS)、Harris髋关节功能评分(HHS)。结果观察组手术切口长度、术中失血量、手术时间、术后下床活动时间、直腿抬高时间、髋外展肌力恢复时间均优于对照组,差异均有统计学意义(P<0.05)。观察组术后1 d血清CK、CRP、ESR水平为(351.37±36.74)U/L、(28.94±8.77)mg/L、(15.75±3.21)mm/h,低于对照组[(403.57±40.68)U/L、(46.55±9.32)mg/L、(26.37±5.36)mm/h],差异均有统计学意义(P<0.05)。观察组术后1、5 d的VAS评分为(4.34±0.85)、(2.78±0.52)分,低于对照组[(5.64±1.22)、(4.13±0.83)分],差异均有统计学意义(P<0.05)。观察组术后1、3个月HHS评分为(77.62±6.38)、(85.64±3.64)分,高于对照组[(68.42±5.61)、(80.61±4.18)分],差异均有统计学意义(P<0.05)。术后6个月随访结果显示,2组并发症发生率比较差异无统计学意义(P>0.05)。结论ERAS背景下直接前方入路全髋关节置换对高龄患者软组织创伤较小,髋关节功能改善效果好,短期康复快。

Objective To explore the effect of direct anterior approach combined with accelerated rehabilitation surgery(ERAS)on the rehabilitation of elderly patients after total hip replacement.Methods From January 2018 to January 2020,97 elderly patients with total hip replacement in Liuzhou Workers'Hospital were retrospectively analyzed.According to different surgical methods,they were divided into control group(n=50)and observation group(n=47).The control group was treated with posterolateral total hip arthroplasty,and the observation group was treated with total hip arthroplasty through direct anterior approach,the general conditions of operation,serum stress indexes[serum creatine kinase(CK),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)],visual analogue scale(VAS)and Harris hip function score(HHS)were compared between the two groups.Results The incision length,intraoperative blood loss,operation time,postoperative ambulation time,straight leg raising time and hip abduction muscle strength recovery time of the observation group were better than those of the control group,the differences were statistically significant(P<0.05).The levels of CK,CRP and ESR in the observation group were(351.37±36.74)U/L,(28.94±8.77)mg/L,(15.75±3.21)mm/h,which were lower than those in the control group[(403.57±40.68)U/L,(46.55±9.32)mg/L,(26.37±5.36)mm/h]at one day after operation,the differences were statistically significant(P<0.05).The VAS scores of the observation group was(4.34±0.85),(2.78±0.52)points,which were lower than those of the control group[(5.64±1.22),(4.13±0.83)points]on 1 d and 5 d after operation,the differences were statistically significant(P<0.05).The HHS scores of the observation group were(77.62±6.38)and(85.64±3.64)points,which were higher than those of the control group[(68.42±5.61),(80.61±4.18)points]at 1 and 3 months after operation,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Under the background of eras,direct anterior total hip arthroplasty has less soft tissue trauma,better hip function improvement and faster short-term rehabilitation in elderly patients.