术后快速康复对全膝关节置换术后功能的影响

Enhanced recovery after surgery on postoperative function for total knee arthroplasty

目的通过对比全膝关节置换术(total knee arthroplasty,TKA)患者术后功能结果,探讨术后快速康复(enhanced recovery after surgery,ERAS)方案对TKA术后功能的影响。方法以首都医科大学附属北京朝阳医院2010年1月1日到2021年12月31日1881例诊断为膝关节骨关节炎的住院患者为研究对象,根据是否应用ERAS方案分为ERAS组和对照组。收集两组患者基本信息、术前和术后1个月的膝关节活动度、美国膝关节协会评分(American Knee Society Score,KSS)、西大略湖和麦克马斯特大学骨关节炎评分(the Western Ontario and McMaster Universities,WOMAC)以及术后1个月患者满意度。结果实施术后快速康复方案后,ERAS组住院时间及住院费用明显低于对照组,组间差异有统计学意义(P<0.01)。术后1个月,ERAS组患者KSS临床和功能评分以及膝关节活动度明显优于对照组,患者术后满意度明显高于对照组,组间差异有统计学意义(P<0.05);而术后1个月WOMAC评分两组差异无统计学意义(P>0.05)。结论应用ERAS方案进行的TKA能够在降低住院时间和住院费用的同时,获得更好的术后功能和满意度。

Objective To investigate the effects of enhanced recovery after surgery(ERAS)on postoperative recovery following total knee arthroplasty(TKA)by comparing postoperative functional results.Methods Depending on whether the ERAS regimen was used,a total of 1881 inpatients who were diagnosed with knee osteoarthritis at Beijing Chaoyang Hospital,Capital Medical University,from January 1,2010 to December 31,2021,were divided into an ERAS group and a control group.Basic information,knee range of motion,American Knee Society Score(KSS),the Western Ontario and McMaster Universities(WOMAC)osteoarthritis score were withdrawn before and one month after surgery.Additionally,the satisfaction was recorded one month after surgery.Results After the implementation of ERAS program,the hospitalization duration and hospitalization cost in ERAS group were significantly lower than those in the control group(P<0.01).At one month after surgery,patients in the ERAS group had significantly greater postoperative satisfaction than patients in the control group and significantly better KSS clinical and functional scores and knee range of motion than patients in the control group(P<0.05).At one month following surgery,there was no apparent change in the WOMAC scores between the two groups(P>0.05).Conclusion Better postoperative function and satisfaction can be attained with TKA using the ERAS protocol,while the hospital duration and cost are decreased.