清单化快速康复外科对膝骨关节炎关节镜手术患者功能恢复的影响

Effect of list-based enhanced recovery after surgery on functional recovery in patients with knee osteoarthritis undergoing arthroscopic surgery

目的观察清单化快速康复外科(ERAS)对膝骨关节炎(KOA)关节镜手术患者功能恢复的影响。方法选择2021年6月至2023年10月雅安市人民医院收治的KOA关节镜手术患者150例作为研究对象,按照随机数表法将其分为常规流程组和清单ERAS组,每组各75例。常规流程组执行常规围手术期的各项措施,清单ERAS组将任务清单融入快速康复外科的术前、术中、术后阶段。分别在术前和术后各时间点采用视觉模拟评分法(VAS)评定疼痛;在术前1 d和术后3、6周比较膝关节Lysholm评分、国际膝关节评分委员会评分2000年版本(IKDC2000)主观评分、Fugl-Meyer平衡量表评分、Berg平衡量表(BBS)评分。结果在疼痛方面,术前1 d,两组VAS评分比较,差异无统计学意义(P>0.05);术后6、24、48、72 h,清单ERAS组VAS评分均低于常规流程组,差异有统计学意义(P<0.05)。在功能恢复方面,术前1 d,两组IKDC2000主观评分、Lysholm评分、Fugl-Meyer平衡评分、BBS评分比较,差异无统计学意义(P>0.05);术后3、6周,清单ERAS组Lysholm评分、BBS评分高于常规流程组,差异有统计学意义(P<0.05);术后6周,IKDC2000主观评分、Fugl-Meyer平衡评分高于常规流程组,差异有统计学意义(P<0.05)。结论清单化ERAS可以有效缓解术后疼痛,加速患者术后平衡、运动功能的恢复。

Objective To observe the effect of list-based enhanced recovery after surgery(ERAS)on functional recovery in patients with knee osteoarthritis(KOA)undergoing arthroscopic surgery.Methods A total of 150 patients with KOA who underwent arthroscopic surgery at Yaan People’s Hospital from June 2021 to October 2023 were selected as the study subjects.They were divided into a conventional procedure group and an listbased ERAS group using the random number table method,with 75 patients in each group.The conventional procedure group carried out routine perioperative measures,while the ERAS group integrated the task list into the preoperative,intraoperative,and postoperative stages of ERAS.Pain was assessed using visual analogue scale(VAS)at various time points before and after surgery.The Lysholm score,International Knee Documentation Committee(IKDC2000)subjective score,Fugl-Meyer balance scale score,and Berg balance scale(BBS)score were compared on day 1 preoperative and 3 and 6 weeks postoperative.Results In terms of pain,there was no significant difference in VAS scores between the two groups one day before surgery(P>0.05).At 6 h,24 h,48 h and 72 h after surgery,the VAS scores in the list-based ERAS group were lower than those in the conventional procedure group,and the differences were statistically significant(P<0.05).In terms of functional recovery,there was no significant difference between the two groups in IKDC2000 subjective score,Lysholm score,Fugl-Meyer balance score and BBS score on the 1st day before surgery(P>0.05).At 3 and 6 weeks after surgery,Lysholm score and BBS score in the list-based ERAS group were higher than those in the conventional procedure group,and the difference was statistically significant(P<0.05).IKDC2000 subjective score and Fugl-Meyer balance score were higher than those in the conventional procedure 6 weeks after surgery,and the difference was statistically significant(P<0.05).Conclusion List-based ERAS can effectively relieve postoperative pain and accelerate the recovery of postoperative balance and motor function.