加速康复理念结合人工股骨头置换术治疗高龄股骨转子间骨折的近期疗效观察

Observation on the Short-Term Effect of Enhanced Recovery after Surgery Concept Combined with Artificial Femoral Head Replacement in the Treatment of Elderly Intertrochanteric Fractures

目的:观察加速康复(ERAS)理念结合人工股骨头置换术治疗高龄股骨转子间骨折的临床疗效。方法:回顾性分析攀枝花市中心医院骨科自2018年1月至2020年12月收治的87例高龄股骨转子间骨折患者的病例资料,根据治疗方法分为观察组(52例)和对照组(35例),两组患者均采用ERAS理念,其中观察组采用人工股骨头置换术,对照组采用股骨近端髓内钉内固定术。比较两组患者术中出血量、输血情况、手术时间、切口长度,术后早期及随访期间并发症发生情况和病死情况、术后下床活动时间、住院时间和满意度情况。结果:两组患者手术时间、输血率、并发症发生率和病死率比较,差异均无统计学意义(P>0.05);观察组患者术中出血量较多、手术切口较长,但下床活动时间和住院时间均比对照组短,且患者满意度高,差异均有统计学意义(P<0.05)。结论:ERAS理念结合人工股骨头置换术治疗高龄股骨转子间骨折能更早改善患者髋关节功能,缓解髋部疼痛,满足患者早期下床活动需求,提高早期生活质量,同时缩短住院时间,提升患者治疗满意度,是一种安全、有效的治疗方法。

Objective:To observe the clinical effect of enhanced recovery after surgery(ERAS)concept combined with artificial femoral head replacement in the treatment of elderly intertrochanteric fractures.Methods:The case data of 87 elderly patients with intertrochanteric fractures admitted to the Department of Orthopedics of Panzhihua Central Hospital from January 2018 to December 2020 were retrospectively analyzed.According to the treatment method,they were divided into an observation group(52 cases)and a control group(35 cases).Both groups adopted the ERAS concept.The observation group was treated with artificial femoral head repla cement,and the control group was treated with proximal femoral nail antirotation(PFNA).Intraoperative blood loss,blood transfusion,operation time,incision length,complications and fatality in the early postoperative period and during follow-up,postoperative out-of-bed time,hospitalization time and satisfaction were evaluated in the two groups.Results:There were no significant differences in operation time,blood transfusion rate,complication rate and fatality rate between the two groups(P>0.05).The patients in the observation group had more intraoperative blood loss and longer surgical incisions,but the time to get out of bed and hospitalization time were shorter than those of the control group,and the patient satisfaction was higher,and the differences were statistically significant(P<0.05).Conclusion:ERAS concept combined with artificial femoral head replacement for the treatment of elderly intertrochanteric fractures can improve the hip function of patients earlier,relieve hip pain,meet the needs of patients for early getting out of bed,improve early quality of life,shorten hospitalization time,and increase patient satisfaction with treatment.It is a safe and effective treatment.