加速康复外科在人工股骨头置换术治疗老年股骨粗隆间骨折中的应用研究  

Clinical study of enhanced recovery after surgery in the treatment of intertrochanteric femoral fracture with artificial femoral head replacement in elderly patients

作　　者：董佩龙[1] 唐晓波[1] 王健[1] 李志云 谢淑君[1] Dong Peilong;Tang Xiaobo;Wang Jian;Li Zhiyun;Xie Shujun(Department of Orthopedics,Affiliated Jianhu Hospital of Nantong University,Yancheng 224700,China)

机构地区：[1]南通大学附属建湖医院骨科,盐城224700

出　　处：《中华老年骨科与康复电子杂志》2021年第3期170-175,共6页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：2018年度江苏省第五期“333工程”科研项目资助计划(BRA2018250);盐城市医学科技发展计划资助项目(YK2017080)。

摘　　要：目的通过临床随机对照研究,探讨加速康复外科(ERAS)在人工股骨头置换术治疗老年股骨粗隆间骨折中的应用效果。方法前瞻性收集2016年02月至2018年02月南通大学附属建湖医院骨科收治的52例符合选择标准的拟定行人工股骨头置换术的老年股骨粗隆间骨折患者。其中26例采用ERAS围手术期方案(试验组),男性12例,女性14例,平均年龄(79.7±3.1)岁,26例采用传统围手术期方案(对照组),男性13例,女性13例,平均年龄(78.8±2.6)岁。比较两组术后2 h血红蛋白及输血比例、术后住院时间(LOS)、术后并发症、术后24 h、1个月、3个月、12个月疼痛视觉模拟评分(VAS)、Harris评分。结果术后患者均获随访,随访时间12~24个月,平均(18±3)个月。试验组术后24 h血红蛋白[(110.4±13.7)g/L]高于对照组[(100.1±9.0)g/L],试验组术后LOS[(3.6±0.8)d]短于对照组[(4.6±0.8)d],差异均有统计学意义(t=3.204,P=0.002;t=3.749,P=0.001),试验组输血比例及术后并发症发生率低于对照组,差异有统计学意义。试验组和对照组术前、术后24 h、1个月、3个月、12个月VAS评分及Harris评分进行重复测量设计的方差分析显示试验组和对照组组间差异有统计学意义,组别与时间点间存在交互作用,各时间点除第一时间点和第五时间点外两组差异均有统计学意义,试验组在各时间点间差异均有统计学意义。结论ERAS理念干预下,人工股骨头置换术治疗老年股骨粗隆间骨折术后失血少、术后住院时间短、并发症发生率低、术后短期疼痛轻,康复快,利于髋关节功能的早期恢复。Objective To investigate the effect of enhanced recovery after surgery(ERAS)in the treatment of intertrochanteric femoral fracture with artificial femoral head replacement in elderly patients.Methods From Feburary 2016 to Feburary 2018,52 patients who underwent the treatment of artificial femoral head replacement with intertrochanteric femoral fracture in elderly patients were randomly divided into two groups:ERAS group(experimental group,n=26,including 12 males and 14 female,with a median age of 79.7±3.1 years)and routine group(control group,n=26,including 13 males and 13 female,with a median age of 78.8±2.6 years).Follow-up assessment included postoperative hemoglobin at 24 hours after operation,blood transfusion ratio,postoperative length of stay(LOS),postoperative complications,VAS score and Harris score at 24 hours,1 month,3 months and 12 months after operation.Results All the 52 patients were followed up for 12-24 months(18±3 months on average).Postoperative hemoglobin at 24 hours after operation in experimental group[(110.4±13.7)g/L]was significantly higher than that in control group[(100.1±9.0)g/L].The postoperative LOS in the experimental group[(3.6±0.8)d]was significantly shorter than that in the control group[(4.6±0.8)d].There were significant differences between the two groups(t=3.204,P=0.002,t=3.749,P=0.001).The blood transfusion ratio and the incidence of complications in the experimental group were significantly lower than those in the control group.There were significant differences between the two groups.The VAS score and Harris score of the experimental group and the control group before and after 24 h,1 month,3 months,12 months of repeated measurement design showed that there were significant differences between the experimental group and the control group.There was interaction between the two groups at different time points.Except for the first time point and the fifth time point,the difference between the two groups was statistically significant.There were statistically significant dif

关 键 词：加速康复外科 关节成形术 置换 髋 老年人 前瞻性研究 

分 类 号：R687.3[医药卫生—骨科学]