加速康复外科理念在老年骨质疏松性腰椎压缩性骨折椎体成形术和后凸成形术后康复中的应用  

Application of enhanced recovery after surgery in postoperative rehabilitation of osteoporotic lumbar compression fractures with percutaneous vertebroplasty or percutaneous kyphoplasty

作　　者：陈星[1] 万趸[1] 熊小明[1] 石华刚[1] 邓轩赓[1] 顾韬 宋偲茂[1] 侯伟[1] 李庆龙 CHEN Xing;WAN Dun;XIONG Xiao-ming;SHI Hua-gang;DENG Xuan-geng;GU Tao;SONG Si-mao;HOU Wei;LI Qing-long(Sichuan Orthopedic Hospital,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省骨科医院,四川成都610041

出　　处：《中国骨伤》2020年第12期1179-1183,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨按照加速康复外科(enhanced recovery after surgery,ERAS)理念指导术后规律性核心肌力训练对老年骨质疏松腰椎压缩性骨折椎体成形术(percutaneous vertebroplasty,PVP)和椎体后凸成形术(percutaneous kyphoplasty,PKP)术后康复的作用。方法:将2016年1月至2018年1月期间94例符合纳入、排除标准的因骨质疏松性腰椎压缩骨折而行PKP或PVP手术的老年患者分成观察组和对照组,术后均常规抗骨质疏松治疗。观察组47例,男18例,女29例,年龄(62.62±3.21)岁;对照组47例,男17例,女30例,年龄(62.38±2.84)岁。对照组按照传统的方式训练,观察组按ERAS理念指导患者规律性核心肌力训练。术后1、3、6个月随访,根据患者的Barthel量表、日本骨科协会(Japanese Orthopaedic Association,JOA)腰痛评分,Oswestry功能障碍指数对患者病情进行量化评估,统计分析。比较两组治疗效果的差异性。结果:94例完成随访,术后1、3个月观察组的Barthel量表、JOA腰痛评分、Oswestry功能障碍指数均优于对照组(P<0.05)。术后6个月观察组的Oswestry功能障碍指数优于对照组(P<0.05),但两组JOA腰痛评分、Barthel量表差异无统计学意义(P>0.05)。两组患者术后1、3、6个月的Barthel量表、JOA腰痛评分、Oswestry功能障碍指数均明显好转(P<0.05)。结论:早期规律性核心力量训练在老年骨质疏松性腰椎压缩骨折PKP或PVP术后早期功能恢复及改善生活能力方面具有积极的作用,符合加速康复外科理念。Objective:To study effects of postoperative regular training of core muscle strength guided by the concept of enhanced recovery after surgery(ERAS)on the rehabilitation of elderly patients with osteoporotic lumbar vertebral compression fracture after vertebroplasty(PVP)and kyphoplasty(PKP).Methods:Ninety-four elderly patients with osteoporotic lumbar compression fractures who underwent PKP or PVP from January 2016 to January 2018 and met inclusion criteria were divided into observation group and control group.All the patients were treated with routine anti-osteoporosis therapy after operation.There were 47 patients in the observation group,including 18 males and 29 females,with an average age of(62.62±3.21)years old;in the control group,there were 47 cases,including 17 males and 30 females,with an average age of(62.38±2.84)years old.The patients in the control group were trained by traditional way,and the patients in observation group were instructed to conduct regular training of core muscle strength according to ERAS concept.The patients were followed up for 1,3 and 6 months after operation.Patients'conditions were quantitatively evaluated according to Barthel scale,JOA low back pain score and Oswestry Disability Index,and the differences in treatment effects between two groups were statistically analyzed and compared.Results:All the patients were followed up,and the Barthel scale,JOA low back pain score and Oswestry Disability Index score of the observation group were all better than those of the control group on the 1st and the 3rd months after surgery(P<0.05).The Oswestry Disability Index score of the observation group on the 6th month after surgery were superior to those of the control group(P<0.05).However,there was no significantly difference in JOA low back pain score and Barthel scale between two groups at 6 months after surgery(P>0.05).The comparison of Barthel scale,JOA low back pain score and Oswestry Disability Index before and after the operation of 1,3 and 6 months between the two groups were si

关 键 词：骨质疏松性骨折 腰椎 骨折 压缩性 椎体成形术 椎体后凸成形术 

分 类 号：R684[医药卫生—骨科学]