加速康复外科理念在指屈肌腱断裂修复术中的应用

Application of enhanced recovery after surgery concept in the repair of finger flexor tendon rupture

目的探讨加速康复外科理念(ERAS)在指屈肌腱断裂修复术中的应用效果。方法回顾性分析2019年10月至2021年9月期间上海市嘉定区安亭医院收治的62例开放性指屈肌腱断裂患者的临床资料。按照围手术期管理方法不同分组,其中32例围手术期间给予ERAS干预及管理者纳入ERAS组,30例围手术期使用传统方式管理者纳入对照组。比较两组患者屈肌腱修复术后1 d、2 d及7 d视觉模拟评分法得分(VAS评分),术后8周手指肌腱总活动度(TAM),术后8周屈肌肌力评定(Lovett)及术后并发症(肌腱黏连、肌腱断裂和创面感染)情况。结果两组患者的性别、年龄、BMI指数和屈肌腱损伤分区比较差异均无统计学意义(P>0.05);术后1 d、2 d及7 d,ERAS组患者的VAS评分分别为(5.34±1.26)分、(4.59±1.16)分、(2.38±0.83)分,明显低于对照组的(6.90±0.96)分、(6.13±0.90)分、(3.67±1.18)分,差异均有统计学意义(P<0.05);术后8周,ERAS组患者的TAM为(166.41±28.05)分,明显高于对照组的(134.93±30.80)分,差异有统计学意义(P<0.05);ERAS组患者的TAM优良率为87.5%,明显高于对照组的63.3%,差异有统计学意义(P<0.05);ERAS组患者屈肌肌力评定4级和5级占84.4%,明显高于对照组的43.3%,差异有统计学意义(P<0.05);ERAS组患者围手术期并发症总发生率为15.6%,明显低于对照组的40.0%,差异有统计学意义(P<0.05)。结论ERAS在屈指肌腱断裂修复术中应用可以有效减少术后患者疼痛、提高术后手指肌腱总活动度及增大屈肌肌力,且安全性较高,具有临床应用价值。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)in the repair of finger flexor tendon rupture.Methods The clinical data of 62 patients with open flexor tendon rupture admitted to Shanghai Jiading District Anting Hospital from October 2019 to September 2021 were retrospectively analyzed.According to different perioperative management methods,32 patients treated with ERAS intervention and management were included in the ERAS group,and 30 treated with traditional perioperative management were included in the control group.The Visual Analogue Scale(VAS)scores at 1,2 and 7 days after flexor tendon repair,total motion of finger tendon(TAM),flexor muscle strength assessment(Lovett)at 8 weeks after surgery,and postoperative complications(tendon adhesion,tendon rupture,and wound infection)were compared between the two groups.Results There were no significant differences in gender,age,BMI,and flexor tendon injury zone between the two groups(P>0.05).At 1,2 and 7 days after operation,the VAS scores of ERAS group were(5.34±1.26)points,(4.59±1.16)points,(2.38±0.83)points,which were significantly lower than(6.90±0.96)points,(6.13±0.90)points,(3.67±1.18)points of the control group(P<0.05).At 8 weeks after operation,TAM of ERAS group was(166.41±28.05)points,which was significantly higher than(134.93±30.80)points of the control group(P<0.05).The excellent and good rate of TAM in ERAS group was 87.5%,which was significantly higher than 63.3%in the control group(P<0.05).Flexor muscle strength assessment grade 4 and 5 accounted for 84.4%in ERAS group,which was significantly higher than 43.3%in control group(P<0.05).The total incidence of perioperative complications in ERAS group was 15.6%,which was significantly lower than 40.0%in the control group(P<0.05).Conclusion ERAS in the repair of flexor tendon rupture can effectively reduce postoperative pain,improve the total range of motion of finger tendon and increase flexor muscle strength,with high safety,which has high clinical application value.