快速康复全膝关节置换的临床结果  

Clinical results of fast track total knee arthroplasty

作　　者：刘福存[1] 童培建[1] 储小兵[1] 邹建琴[1] 任洁[1] 郭燕威[1] 

机构地区：[1]浙江中医药大学第一临床医学院骨伤科,杭州310006

出　　处：《中华骨科杂志》2016年第18期1185-1190,共6页Chinese Journal of Orthopaedics

基　　金：浙江省自然科学基金一般项目（LY16H060005）;中国博士后科学基金面上项目（2014M561793）;中国博士后科学基金特别资助课题（2015T80637）

摘　　要：目的探讨快速康复外科流程对全膝关节置换术后康复时间及患者满意度的影响。方法收集2013年8月至2015年3月208例原发性骨关节炎患者资料，随机分为快速康复膝关节置换（total knee arthroplasty，TKA）组，即遵循围手术期临床医学证据，严格执行快速康复程序；以及传统TKA组，沿袭传统手术管理模式。对两组患者严格制定相同的出院标准，以判断康复时间；采用数值评定量表评估术后2周的满意度；记录并发症、输血率、3个月内感染、血栓相关事件、再手术和死亡情况等。结果快速康复TKA组达到出院标准的时间平均（2．3±1．2）d，少于传统TKA组的（4．7±5．1）d，差异有统计学意义；快速康复TKA组与传统TKA组患者满意度数值评定量表（numerical rating scale，NRS）评分得分为（9．8±0．5）分和（9．1±1．4）分，差异有统计学意义。快速康复TKA组术前患者信息获得满意度为（27．7±7.3）分，术后疼痛控制满意度（9．8±1．7）分，术后功能获得满意度（9．6±1．3）分，均高于传统TKA组的（15．5±10．1）分、（9．2±2．2）分及（8．7±1．8）分，差异均有统计学意义；快速康复TKA组术后输血率为3．9％，低于传统TKA组的11．4％，差异有统计学意义。结论快速康复TKA可缩短患者住院时间，不增加并发症的发生率及死亡率，能使患者快速恢复日常活动，患者满意度提高。Objective To evaluate the effect of fast-track TKA upon the recovery time and degree of satisfaction of the patients. Methods 208 patients with primary osteoarthritis between 2013 and March 2015 were randomly divided into 2 groups. In fast-track TKA group was established in peri-operative analgesia, blood management, postoperative antieoagulation, surgical skill and mitigation of perioperative stress. In TKA group, conventional surgical management mode was followed. Identical dis- charge standards were established for patients in 2 groups to evaluate the recovery time. The patients＂ degree of satisfaction at post- operative 2 weeks was assessed by numerical rating scale （NRS）. The degree of satisfaction about acquisition of preoperative infor- mation, degree of satisfaction about postoperative analgesia and postoperative function were statistically compared between 2 groups. Postoperative complication, blood transfusion rate, infectious events within postoperative 3 months, thrombosis-related events, re-operation and death were recorded. Results In fast-track TKA group, the mean discharge time was （2.3±1.2） d, signifi- cantly shorter compared with （4.7±5.1） d in TKA group. The mean NRS score in fast-track TKA group was 9.8±0.5 and 9.1±1.4 in TKA group. In fast-track TKA group, the mean scores of the degree of satisfaction about acquisition of preoperative information, de- gree of satisfaction about postoperative analgesia and postoperative function were 27.7±7.3, 9.8± 1.7 and 9.6±1.3, significantly higher than 15.5±10.1, 9.2±2.2 and 8.7±1.8 in the TKA group. In fast-track TKA group, postoperative blood transfusion rate was 3.9%, considerably lower than 11.4% in TKA group. Conclusion Fast-track TKA can shorten the length of hospital stay, not in- crease the mortality rate and postoperative complication, accelerate the recovery of daily activity and effectively enhance the de- gree of satisfaction of the patients.

关 键 词：康复 关节成形术 置换 膝 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]