加速康复外科理念在腓骨瓣游离移植治疗长段骨缺损中的应用  

Application of enhanced recovery after surgery principles in treating long bone defect with free fibula graft

作　　者：王正 喻爱喜[1,2] 漆白文 肖卫东[1] 赵勇 李宗焕[1] Wang Zheng;Yu Aixi;Qi Baiwen;Xiao Weidong;Zhao Yong;Li Zonghuan(Department of Trauma and Micro-orthopaedics,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Center of Wuhan Clinical Medical Research of Microsurgery,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院创伤与显微骨科,武汉430071 [2]武汉市显微外科临床医学研究中心,430071

出　　处：《中华显微外科杂志》2019年第5期463-466,共4页Chinese Journal of Microsurgery

摘　　要：目的总结加速康复外科(ERAS)理念在腓骨瓣游离移植(FVFG)治疗长段骨缺损中的应用经验。方法2012年1月至2017年1月,对26例长段骨缺损行带血管蒂FVFG的患者应用ERAS理念,通过加强心理护理与营养支持、优化手术方案、强化疼痛管理、早期功能锻炼等一系列综合措施,出院后门诊定期随访,记录手术时间、住院时间、患者出院满意度、术后疼痛视觉模拟量表(VAS)评分、骨缺损愈合时间、患肢功能恢复情况。结果本组平均手术时间(3.2±0.5)h,平均住院时间为(10.2±1.2)d,出院满意度超过95%,术后VAS评分小于3分。随访时间1.6~6.0年,26例腓骨瓣全部成活,骨缺损部位均骨性愈合,平均愈合时间(5.5±0.6)个月。术后1.5年,7例上肢功能恢复80.1%,19例下肢功能恢复82.5%。结论ERAS理念应用于FVFG修复长段骨缺损,术后患肢功能恢复良好,疼痛明显减轻,缩短了住院时间,促进了患者康复,患者满意度高。Objective To summarize the application of enhanced recovery after surgery(ERAS)principles in treating long bone defect with free fibula graft(FVFG).Methods From January,2012 to January,2017,ERAS principles were applied in 26 cases of long bone defect treating with vascularized fibula flap graft,via a series of comprehensive measures,including strengthening psychological nursing,nutrition support and pain management,optimizing operation plan,and early scientific functional exercise.Surgical duration,hospital stay time,satisfaction of patients,postoperative visual analogue scale(VAS)score,bone defect healing time,and Enneking score were recorded through regular outpatient follow-up after discharge.Results The average length of surgical duration and hospital stay time was(3.2±0.5)h and(10.2±1.2)d,respectively.Discharged satisfaction was greater than 95%.Postoperative VAS score was less than 3.During the follow-up period of 1.6-6.0 years,26 fibular flap survived,and all the bone defect were healed,with an average healing time of(5.5±0.6)months.Followed-up at 1.5 years after the operation,the upper limb function of 7 patients increased by 80.1%,and the lower limb function of 19 patients increased by 82.5%.Conclusion The application of ERAS in treating long bone defect with FVFG can obtain satisfactory limb function,alleviate patients’pain,shorten the duration of hospitalization,promote the rehabilitation and satisfaction of patients.

关 键 词：加速康复外科 腓骨瓣 移植 骨缺损 长段 

分 类 号：R47[医药卫生—护理学]