快速康复外科理念在老年股骨转子间骨折术后早期康复的应用  

Application of enhanced recovery after surgery in early postoperative rehabilitation of elderly patients with intertrochanteric fracture

作　　者：吴颖 宋雪 王啸 霍利鹏 覃鼎文 危杰[2] Wu Ying;Song Xue;Wang Xiao;Huo Lipeng;Qin Dingwen;Wei Jie(Department of Rehabilitation,Intech Rehabilitation Hospital,Beijing 100176,China)

机构地区：[1]首都医疗集团北京英智康复医院康复科,北京100176 [2]北京积水潭医院创伤骨科

出　　处：《骨科临床与研究杂志》2018年第5期301-304,共4页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨快速康复理念(ERAS)在老年股骨转子间骨折术后早期康复介入的意义。方法选取2016年9月至2017年10月首都医疗集团北京英智康复医院收治的老年股骨转子间骨折术后早期康复患者55例。通过ERAS宣教、运动治疗及物理因子治疗等措施对患者进行干预。采用疼痛视觉模拟量表(VAS)评估患者的疼痛情况,采用关节活动度(ROM)和Harris评分评估患者髋关节功能恢复情况,采用汉密尔顿焦虑量表(HAMA)评估患者的心理焦虑状况,采用功能独立性评定量表(FIM)评估患者的功能恢复情况,采用日常生活活动能力量表(ADL)评估患者的日常生活能力。结果 55例患者平均康复治疗时间为12.25周。康复治疗前后的VAS评分分别为(6.20±2.37)分和(2.10±1.12)分,屈髋角度分别为(57.20±3.35)°和(108.00±4.66)°,HAMA评分分别为(15.23±2.01)分和(5.12±1.23)分,FIM评分分别为(75.20±2.36)分和(108.45±1.87)分。康复治疗前后患者的疼痛程度、ROM、心理焦虑和功能障碍等方面差异均有统计学意义(P均<0.01)。康复治疗前肌力为股四头肌3-级,臀大肌2+级,臀中肌2级;康复治疗后肌力为股四头肌4+级,臀大肌4级,臀中肌4级。全部患者骨折均愈合,未发生并发症。患者术后6个月复查结果显示,平均Harris评分为(92.00±1.42)分,其中63分1例,76分3例,优良率为92.72%。结论老年股骨转子间骨折术后早期康复治疗对患者髋关节功能恢复和提高手术近期疗效有重要的促进意义。康复治疗是临床ERAS的必要补充。Objective To investigate the significance of enhanced recovery after surgery（ERAS）in the early rehabilitation of elderly patients with intertrochanteric fracture.MethodsA total of 55 elderly patients with intertrochanteric fractures were treated with early rehabilitation from September 2016 to October 2017 in Intech Rehabilitation Hospital.Early rehabilitation included ERAS education,exercise therapy,and physical factor therapy.The pain visual analog scale（VAS）was used to assess the patient＇s pain,the range of motion（ROM）and the Harris Hip Score（HHS）were used to assess hip recovery,the Hamilton anxiety scale（HAMA）was used to assess the patient＇s psychological anxiety,the Functional Independence Measure（FIM）was used to assess the patient＇s dysfunction,the activities of daily living（ADL）was used to assess the patient＇s ability to live.Results The average rehabilitation intervention time was 12.25 weeks.Fifty-five patients had significant improvements in the VAS score[（6.20±2.37）vs.（2.10±1.12）],the hip flexion average degrees[（57.20±3.35）°vs.（108.00±4.66）°],the FIM average score[（75.20±2.36）vs.（108.45±1.87）],and the HAMA average score[（15.23±2.01）vs.（5.12±1.23）],all P〈0.01.After rehabilitation intervention treatment,the quadriceps femoris strength increased from 3-to 4＋,gluteus maximus increased from 2＋to 4 and gluteus medius increased from 2 to 4 grade.All fractures healed and no complications occurred.The Harris score was（92.0±1.42）points,of which one case was 63 points and 3 cases were76 points,and the excellent rate was 92.72%at 6 months after rehabilitation intervention treatment.Conclusion Early rehabilitation intervention for elderly patients with intertrochanteric fracture plays an important role in promoting hip functional recovery and short-term effect of surgical treatment.Rehabilitation is a necessary supplement to the concept of clinical ERAS.

关 键 词：髋骨折 股骨 康复 

分 类 号：R473.6[医药卫生—护理学]