加速康复模式下不同程度骨质疏松的老年粗隆间骨折患者180天术后比较研究  

A followed-up 180 days comparative study of elderly patients with intertrochanteric fracture between ERAS and conventional Surgery in different degrees of osteoporosis

作　　者：谭科[1] 杨浩[1] 杨林[1] 聂海[1] 王志晖[1] Tan Ke;Yang Hao;Yang Lin;Nie Hai;Wang Zhihui(Department of Orthopedic,Eastern Hospital,Sichuan Provincial Medical Sciences Academy&Sichuan Provincial People's Hospital,Chengdu 610101,China)

机构地区：[1]四川省医学科学院·四川省人民医院(东院)骨科,成都610101

出　　处：《中华老年骨科与康复电子杂志》2021年第4期207-214,共8页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：2020年西南医科大学自然科学重点项目(2020XYLH-013)。

摘　　要：目的研究快康复模式在不同程度骨质疏松的老年粗隆间骨折患者术后180 d的治疗效果。方法本研究回顾了2014年1月1日至2016年12月31日四川省人民医院骨科收治的70岁以上老年粗隆间骨折手术患者208例,并进行了180 d以上的随访,分为加速康复外科组与常规对照组,其中加速康复外科组102例,男性39(38.2%)例,年龄(74±4)岁;常规对照组106例,男性44(41.5%)例,年龄(73±5)岁。按照Singh指数评分分层方式分别比较了加速康复外科组与常规对照组在不同Singh分级下的围手术期各项临床和实验室指标差异以及术后180 d内的Harris评分。结果208例患者获得随访,随访时间(311±54)d,加速康复外科组患者术中失血量(t=7.300,P=0.001)、手术时间(t=21.600,P<0.001)、切口长度(W=15.467,P<0.001)均小于常规对照组,住院时间较常规对照组更短(W=9996.500,P<0.001),术后患者部分负重时间更早(t=75.454,P<0.001),且患者180 d预后的功能Harris评分显示,快康复组在不同Singh分级下均优于常规对照组,不同Singh评分组的预后差异有统计学意义。结论以围绕减少患者卧床时间为核心的快康复模式具有更好的围手术期管理以及预后效果,是一种值得推广的模式。Objective To investigate the effect of ERAS on the treatment of intertrochanteric fracture in elderly patients with different degrees of osteoporosis.Methods We enrolled 208 patients from January 1,2014 to December 31,2016 in our hospital orthopaedic,which were over 70 elderly patients with intertrochanteric fracture surgery and followed-up over 180 days.102 patients with ERAS included enhanced recovery after surgery(ERAS)39(38.2%)males,aged 74±4 years and 106 patients with conventional control group included 44(41.5%)males,aged 73±5 years.Then we compared the differences in perioperative clinical and laboratory indexes and Harris scores within 180 days after surgery.Results ERAS group showed less blood loss(t=7.300,P<0.001),less operative time(t=21.600,P<0.001),shorter incision length than the conventional control group(W=15.467,P<0.001),the length of admission is shorter than conventional control group(W=9996.500,P<0.001),postoperative patients with partial weight bearing time earlier(t=75.454,P<0.05),the Harris scores of patients with followedup 180 days showed better than the conventional group under different Singh scores;and the prognosis of different Singh scores showed significant difference.Conclusion ERASbased on the shorter bedbound time of patientshasbetter intraoperativemanagementandbetter prognosis effect,andisamodelworthpopularizing.

关 键 词：快速康复外科 骨质疏松症 老年人 髋骨折 

分 类 号：R687.3[医药卫生—骨科学]