多学科协作管理模式在老年全髋关节置换术可行性研究

Feasibility study of a multi-disciplinary team management model in geriatric total hip arthroplasty

目的评估多学科协作(multi-disciplinary team,MDT)管理模式对老年全髋关节置换术(total hip arthroplasty,THA)患者预后的影响。方法选取我院2019年1月至2023年6月采用THA治疗的120例老年髋部骨折患者。根据随机数字表法将患者分为观察组和对照组,每组60例。对照组采用常规管理模式,观察组采用MDT管理模式。评估两组患者围术期相关指标[术前等待时间、手术时间、术中失血量、隐性失血量(hidden blood loss,HBL)及住院时间],疼痛程度,髋部功能,活动能力,术后并发症和生活质量。结果观察组术前等待时间、术中失血量、HBL及住院时间均少于对照组(P<0.05);出院、术后1个月、3个月及6个月时,观察组疼痛视觉模拟评分(visual analogue scale,VAS)低于对照组,Harris髋关节功能评分量表(Harris hip score,HHS)及Barthel指数(Barthel index,BI)分数高于对照组(P<0.05)。观察组并发症发生率低于对照组(8.3%vs.26.7%,P=0.008);术后6个月时,观察组健康调查简表(36-item short form,SF-36)中生理职能、躯体疼痛、活力、社会功能及情绪问题分数均高于对照组(P<0.05)。结论MDT管理模式能够优化老年THA患者围术期指标,早期降低患者术后疼痛,提高患者髋部功能,日常生活能力和生活质量。

Objective To assess the impact of a multi-disciplinary team (MDT) management model on elderly total hip arthroplasty (THA) patients.Methods One hundred and twenty elderly hip fracture patients treated with THA between January 2019 and June 2023 in our hospital were selected.The patients were divided into observation and control group according to the randomized numerical table method,with 60 cases in each group.Conventional management mode was used in the observation group,and MDT management mode was used in the observation group.Perioperative related indicators[preoperative waiting time,operation time,intraoperative blood loss,hidden blood loss (HBL) and hospitalization time],pain level,hip function,mobility,postoperative complications and quality of life were assessed in both groups.Results Preoperative waiting time,intraoperative blood loss,HBL and hospital stay were less in the observation group than in the control group (P < 0.05);At discharge,1 month,3 months and 6 months postoperatively,the visual analogue scale (VAS) of the observation group was lower than that of the control group,and the scores of Harris hip score (HHS) and Barthel index (BI) were higher than those of the control group (P < 0.05).The complication rate was lower in the observation group than in the control group (8.3% vs.26.7%,P=0.008);At 6 months postoperatively,the scores of physical functioning,somatic pain,vitality,social functioning,and emotional problems by the Health Survey 36-item Short Form (SF-36) were higher in the observation group than in the control group (P < 0.05).Conclusions The MDT management model can optimize perioperative metrics and reduce postoperative pain at an early stage for elderly patients with THA,while improving hip function,daily activities,and quality of life.