加速康复外科管理模式在初次单髁关节置换中的临床应用观察  

Effectiveness of enhanced recovery after surgery on primary unilateral unicompartment knee arthroplasty

作　　者：张启栋[1] 刘沛 卢非凡 黄诚 丁冉[1] 王佰亮[1] 刘朝晖[1] 程立明[1] 王卫国[1] 郭万首[1] ZHANG Qi-dong;LIU Pei;LU Fei-fan;HUANG Cheng;DING Ran;WANG Bai-liang;LIU Zhao-hui;CHENG Li-ming;WANG Wei-guo;GUO Wan-shou(Department of Orthopaedic Surgery,China-Japan Friendship Hospital,Beijing,100029,China)

机构地区：[1]中日友好医院骨科一部,北京100029

出　　处：《中国骨与关节杂志》2020年第10期746-751,共6页Chinese Journal of Bone and Joint

基　　金：首都卫生发展科研专项(2020-2-4067);国家自然科学基金(81972130);国家自然科学基金(81703896)。

摘　　要：目的评价加速康复外科 (enhanced recovery after surgery,ERAS) 管理模式在初次单侧膝关节单髁置换 (unicompartmental knee arthroplasty,UKA) 术后早期的临床疗效及患者满意度,比较其与非 ERAS 管理模式的差异。方法回顾分析 2015 年 1 月至 2016 年 6 月连续进行的 100 例按照 ERAS 模式管理的初次单侧 UKA 患者 (ERAS 组) 临床资料,其中男 24 例,女 76 例,平均年龄 (67.8±7.4) 岁,左侧 48 例,右侧 52 例,与 2013 年 6 月至 2014 年 12 月非 ERAS 模式管理的连续进行的 100 例 UKA (非 ERAS 组) 进行对照研究,比较两组术后早期临床结果和患者主观满意度差异。结果术后 3 天、1 周、6 周时,ERAS 组的疼痛视觉模拟评分 (visual analogue scale,VAS) 明显低于非 ERAS 组 (P<0.001),但是术后 3 个月、6 个月、12 个月时两组 VAS 评分差异无统计学意义 (P=0.148,P=0.364,P=0.836)。术后 3 天时,ERAS 组血红蛋白下降值低于非 ERAS 组 (P=0.001)。术后 6 周内,ERAS 组的美国特种外科医院膝关节 (hospital for special surgery,HSS)评分和膝关节活动度均高于非 ERAS 组,差异有统计学意义 (P<0.05),然而术后 12 个月时两者差异均无统计学意义 (P>0.05)。在并发症发生率和住院时间方面,ERAS 组均低于非 ERAS 组,差异有统计学意义 (P=0.038,P=0.010)。ERAS 组术后整体满意度高,满意度评分及满分人数均明显高于非 ERAS 组 (P=0.021,P=0.031)。结论对于行初次单侧 UKA 的患者,ERAS 管理模式术后早期临床疗效更显著,能够更有效地控制疼痛,减少出血,改善膝关节功能,缩短住院时间,降低并发症发生,加速术后康复,提高患者满意度。Objective To evaluate the effectiveness of enhanced recovery after surgery (ERAS) on primary unilateral unicompartment knee arthroplasty (UKA),and to compare rehabilitation efficacy and patients’ satisfaction with conventional treatment.Methods A retrospective study was conducted on 100 primary unilateral UKA patients after ERAS (ERAS group) from January 2015 to June 2016,including 24 males and 76 females with an average age of (67.8±7.4) years.There were 48 cases on the left side and 52 cases on the right side.The control group (non-ERAS group) included 100 patients who underwent primary unilateral UKA with conventional pathway (non-ERAS group) between June 2013 and December 2014.Postoperative clinical results and patients’ satisfaction were compared between the two groups.Results VAS of the ERAS group was statistically significant lower than that of the non-ERAS group 3 days,1 week and 6 weeks after surgery,but no significant differences were observed 3 months,6 months and 12 months after surgery (P=0.148,P=0.364,P=0.836).The decrease value of hemoglobin of the ERAS group was lower than that of the non-ERAS group 3 days postoperatively (P < 0.05);Hospital of special surgery (HSS) score and knee range of motion of the ERAS group were higher than that of the non-ERAS group with statistically significant differences within 6 weeks after surgery (P < 0.05);However,the indexes above showed no significant differences between the two groups 12 months after surgery (P > 0.05).Complication rate and hospital stay of the ERAS group was lower than that of the non-ERAS group (P=0.038,P=0.010).Postoperative satisfaction rate and the number of full mark of ERAS group were significantly higher than that of non-ERAS group (P=0.021,P=0.031).Conclusions ERAS after primary unilateral UKA can effectively control pain,improve knee functions,shorten hospital stay,accelerate postoperative rehabilitation,improve patients’ satisfaction reduce bleeding and complications.

关 键 词：关节成形术 置换 膝 康复 加速康复外科 

分 类 号：R687.4[医药卫生—骨科学]