加速康复外科多学科协作模式的单侧全膝关节置换效果  

Effect of enhanced recovery after surgery together with multidisciplinary team strategy on unilateral total knee arthroplasty

作　　者：王泽峰 郑勇强[1] 林亮[1] 林鹏 洪天生 田夏阳 庄晓强 李俊豪 李英莲[2] 张金山[1] Wang Zefeng;Zheng Yongqiang;Lin Liang;Lin Peng;Hong Tiansheng;Tian Xiayang;Zhuang Xiaoqiang;Li Junhao;Li Yinglian;Zhang Jinshan(Department of Orthopedics,Jinjiang Municipal Hospital,Quanzhou 362200,China;Department of Rehabilitation Medicine,Jinjiang Municipal Hospital,Quanzhou 362200,China)

机构地区：[1]晋江市医院(上海市第六人民医院福建医院)骨科,泉州362200 [2]晋江市医院(上海市第六人民医院福建医院)康复医学科,泉州362200

出　　处：《中华关节外科杂志（电子版）》2023年第2期224-231,共8页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：泉州市科技计划项目(2019C069R,2020N079s)

摘　　要：目的探讨临床多学科团队(MDT)协作下实施加速康复外科(ERAS)模式对单侧全膝关节置换术(TKA)临床效果的影响。方法纳入2018年9月至2021年12月在晋江市医院骨科诊断为终末期膝骨关节炎、并接受单侧全膝关节置换术的患者,排除患侧膝关节手术史、合并感染或肿瘤或慢性疼痛疾病、不能配合试验评估者。共纳入102例,其中男21例,女81例,年龄40~89岁。随机数字表法分为ERAS-MDT模式治疗组(ERAS-MDT组)和传统模式治疗组(常规组)各51例。收集以下组间数据:基线资料、术后8、24、48、72 h运动疼痛视觉模拟评分(VAS)、术后2、5 d膝关节主动活动度(AROM)、术后2、5 d美国纽约特种外科医院(HSS)膝关节评分、术后1 d血C-反应蛋白(CRP)水平、输血率、术后并发症发生率。采用独立样本t检验、重复测量方差分析、Mann-Whitney秩和检验、卡方检验、Fisher确切概率法进行统计学分析。结果ERAS-MDT组术后8、24、48和72 h VAS评分均低于常规组(t=-2.945、-4.894、-5.676、-5.055,均为P<0.05);ERAS-MDT组术后2、5 d膝关节AROM分别为(68.8±19.1)°、(93.9±14.0)°,均优于常规组的(59.8±21.6)°、(86.2±14.0)°(t=2.223、2.786,均为P<0.05);ERAS-MDT组术后2、5 d膝关节HSS评分为(46.8±6.5)分、(59.8±6.8)分,均优于常规组的(43.4±6.8)分、(52.8±5.8)分(t=2.620、5.575,均为P<0.05);ERAS-MDT组术后1 d血CRP与常规组差异无统计学意义(Z=-0.400,P>0.05);两组在输血率和术后并发症发生率方面差异均无统计学意义(均为P>0.05)。结论ERAS-MDT模式较传统治疗模式能更有效缓解单侧TKA患者术后早期疼痛,改善关节功能,达到加速康复的临床效果。Objective To investigate the impact of the enhanced recovery after surgery(ERAS)protocols under the collaboration of a clinical multidisciplinary team(MDT)on unilateral total knee arthroplasty(TKA).Methods From September 2018 to December 2021,the patients who were diagnosed as terminal knee osteoarthritis and underwent unilateral total knee arthroplasty in the orthopedic department of Jinjiang Municipal Hospital were enrolled.Exclusion criteria:history of knee surgery,concurrent infection or tumor,or chronic pain disease,and inability to cooperate with trial assessment.A total of 102 patients were enrolled,including 21 males and 81 females,aged from 40 to 89 years.Patients were randomly assigned into an ERAS-MDT treatment group(ERAS-MDT group,n=51)and a conventional treatment group(routine group,n=51)by random number table.The following data were collected:baseline data,visual analogue scale(VAS)scores for kinesalgia at eight hours,and 24,48,and 72 h,active range of motion(AROM)of knee and the Hospital for Special Surgery(HSS)knee score on the second and fifth days after surgery,C-reactive protein(CRP)on the first day after surgery,transfusion rate,and postoperative complication rate.Independent t test,repeated measures ANOVA,Mann-Whitney test,chi square test and Fisher exact test were performed for data analysis.Results VAS scores at eight hours,and 24,48,72 h in ERAS-MDT group were significantly lower than those in routine group(t=-2.945,-4.894,-5.676,-5.055,all P<0.05).Knee AROM in the ERAS-MDT group was(68.8±19.1)°and(93.9±14.0)°on the second and fifth days after surgery,both significantly higher than those in the routine group(59.8±21.6)°and(86.2±14.0)°(t=2.223,2.786,both P<0.05).HSS scores on the postoperative second and fifth days in ERAS-MDT group were(46.8±6.5),(59.8±6.8),which were higher than those in the routine group(43.4±6.8),(52.8±5.8)(t=2.620,5.575,both P<0.05).CRP level on the day after surgery showed no statistically significant difference between ERAS-MDT group and routine group(Z=-

关 键 词：术后加速康复 跨部门合作 关节成形术 置换 膝 

分 类 号：R687.4[医药卫生—骨科学]