加速康复外科管理模式在膝关节结核病灶清除手术治疗中的应用

Effect of enhanced recovery after surgery management in the surgical treatment of knee joint tuberculosis

目的:评价加速康复外科(enhanced recovery after surgery,ERAS)管理模式在膝关节结核病灶清除手术治疗中的应用价值。方法:回顾性分析2018年1月至2020年10月首都医科大学附属北京胸科医院骨科,在ERAS管理模式下行膝关节结核病灶清除手术治疗的患者35例(ERAS组),与2015年12月至2017年12月常规围手术期管理模式下连续进行的膝关节结核病灶清除手术35例(非ERAS组)进行对照研究。对比出血量、术后总引流量、术后下肢深静脉血栓发生情况、刀口一期愈合情况、住院时间;分别应用疼痛视觉模拟评分(visual analogue scale,VAS)与美国特种外科医院(hospital of special surgery,HSS)膝关节评分评价患者术前与术后8周时疼痛程度与膝关节功能。结果:ERAS组出血量为(65.0±12.2)ml,较非ERAS组的(125.8±35.0)ml明显减少;ERAS组术后总引流量为(212.9±32.2)ml,较非ERAS组的(408.6±51.9)ml明显减少;ERAS组住院时间为(19.1±2.4)d,较非ERAS组的(28.5±9.7)d明显缩短。两组比较差异均有统计学意义(t值分别为-5.085、-11.203、-3.278,P值均<0.05)。ERAS组无术后下肢深静脉血栓发生,非ERAS组发生2例。ERAS组35例刀口一期愈合,非ERAS组31例。术后8周时,ERAS组VAS评分为(2.6±0.8)分,较术前的(7.7±0.7)分明显降低;HSS评分为(77.4±3.8)分,较术前的(36.5±4.1)分明显提高。ERAS组两种评分手术前后比较差异均有统计学意义(t值分别为18.419、-29.654,P值均<0.05)。非ERAS组VAS评分为(3.9±1.0)分,较术前的(8.0±0.8)分明显降低;HSS评分为(68.3±5.0)分,较术前的(36.4±4.6)分明显提高,非ERAS组两种评分手术前后比较差异均有统计学意义(t值分别为14.807、-12.771,P值均<0.05)。术后8周时,ERAS组VAS评分较非ERAS组明显降低,HSS评分较非ERAS组明显提高,差异均有统计学意义(t值分别为-2.751、4.502,P值均<0.05)。结论:膝关节结核病灶清除手术围手术期应用ERAS管理,可以减轻术后疼痛症状,改善关节功能,减少出血量与引流量,缩短住院时间,达到促进患者快速康复、减少并发症的目的。

Objective:To evaluate the clinical effect of enhanced recovery after surgery(ERAS)management model in patients undergoing surgery for debriding knee joint tuberculosis lesion.Methods:A retrospective analysis was performed on clinical data of 35 patients who underwent knee joint tuberculosis debridement surgery under ERAS management(ERAS group)in the Department of Orthopedics of the Capital Medical University Affiliated Beijing Chest Hospital from January 2018 to October 2020.A control group was established with 35 knee joint tuberculosis debridement surgery patients who underwent non-ERAS management(non-ERAS group)consecutively enrolled from December 2015 to December 2017.The amount of blood loss,postoperative total drainage flow,postoperative deep vein thrombosis in lower extremities,first-stage incision healing and length of hospital stay were compared.Visual analogue scale(VAS)and hospital of special surgery(HSS)knee score were used to evaluate the degree of pain and knee function before and 8 weeks after surgery.Results:The average amount of blood loss in ERAS group((65.0±12.2)ml)was significantly lower than that in non-ERAS group((125.8±35.0)ml),the total postoperative drainage in ERAS group((212.9±32.2)ml)was significantly lower than that in non-ERAS group((408.6±51.9)ml),the hospitalization length in ERAS group((19.1±2.4)days)was significantly shorter than that in non-ERAS group((28.5±9.7)days),and the differences were all statistically significant(t were-5.085,-11.203 and-3.278,respectively,all P values<0.05).No postoperative lower extremity deep vein thrombosis occurred in ERAS group,and 2 cases occurred in non-ERAS group.First-stage healing occurred in 35 cases in ERAS group and 31 cases in non-ERAS group.At 8 weeks after surgery,average VAS score in ERAS group(2.6±0.8)was significantly lower than that before surgery(7.7±0.7),and average HSS score(77.4±3.8)was significantly higher than that before surgery(36.5±4.1),with statistically significant differences(t were 18.419 and-29.654,respectively,both P values<0.05).There were significant differences between the two scores before and after operation in the non-ERAS group(t were 14.807 and-12.771,respectively,all P values<0.05).At 8 weeks after surgery,average VAS score in ERAS group(2.6±0.8)was significantly lower than that in non-ERAS group(3.9±1.0),and average HSS score in ERAS group(77.4±3.8)was significantly higher than that in non-ERAS group(68.3±5.0),with statistically significant differences(t were-2.751 and 4.502,respectively,both P values<0.05).Conclusion:Appling the ERAS management in perioperative period for patients taking knee joint tuberculosis debridement surgery can alleviate postoperative symptoms,improve joint function,reduce blood loss and drainage,and shorten hospitalization time.ERAS management model can promote rapid recovery,reduce complications for patients.