加速康复外科理念下骨盆骨折的围手术期康复措施:一项前瞻性随机对照研究  

Perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery for pelvic fractures:a prospective randomized control trial

作　　者：王金辉[1] 葛宇峰 郭险峰[2] 陶莉[2] 刘晓华[2] 李蔷[2] 王宇章 杨明辉[1] 朱仕文[1] 王振中 金霖[3] 侯志勇[3] 贾健[4] 王连成[4] 余斌[5] 吴新宝[1] Wang Jinhui;Ge Yufeng;Guo Xianfeng;Tao Li;Liu Xiaohua;Li Qiang;Wang Yuzhang;Yang Minghui;Zhu Shiwen;Wang Zhenzhong;Jin Lin;Hou Zhiyong;Jia Jian;Wang Liancheng;Yu Bin;Wu Xinbao(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Rehabilitation Medicine,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedic Trauma,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Orthopaedic Trauma,Tianjin Hospital,Tianjin 300211,China;Division of Orthopaedics of Traumatology,Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]北京积水潭医院康复医学科,100035 [3]河北医科大学第三医院创伤骨科,石家庄050051 [4]天津医院创伤骨科,300211 [5]南方医科大学南方医院骨科-创伤骨科,广州510515

出　　处：《中华创伤骨科杂志》2021年第10期850-855,共6页Chinese Journal of Orthopaedic Trauma

基　　金：京津冀协同创新推动项目(Z171100004517008)。

摘　　要：目的评价基于加速康复外科(ERAS)理念下的骨盆骨折围手术期康复措施的有效性和安全性。方法采用前瞻性随机对照研究的方法,纳入2019年6月至2020年12月北京积水潭医院创伤骨科急诊收治入院行手术治疗的114例骨盆骨折患者,按照随机数字表法分为试验组57例,男42例,女15例;年龄18~77岁;患者采用初步建立的基于ERAS理念的围术期康复途径进行治疗,阶段性调整康复计划;对照组57例,男40例,女17例;年龄17~70岁;患者围手术期采用常规骨盆骨折康复措施,即术后院内会诊-康复医师指导模式。比较两组患者术后2、6、12、24周的骨盆Majeed评分、Barthel指数,以及术后12、24周的早期疼痛程度、健康状况调查简表(SF-36)。结果共105例患者完成随访,时间151~254 d(平均177 d),其中试验组55例,对照组50例。两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。术后2、6、12、24周试验组患者的Majeed评分[(44±13)、(67±16)、(86±14)、(98±7)分]和Barthel指数(57±13、79±16、95±8、100±2)均显著高于对照组[(35±16)、(51±16)、(73±14)、(91±12)分和(45±19、67±18、86±12、98±4)],术后12、24周试验组患者的SF-36评分[(129±15)、(141±6)分]均显著高于对照组[(114±15)、(131±12)分],差异有统计学意义(P<0.05)。两组患者术后12、24周疼痛程度比较差异均无统计学意义(P>0.05)。结论与常规骨盆骨折治疗相比,基于ERAS理念的围手术期康复途径可以改善骨盆骨折患者的早期功能,有助于患者尽早恢复日常生活自理能力。Objective To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery(ERAS)for pelvic fractures.Methods A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma,Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020.Of them,57 were assigned into an intervention group according to a random digits table.They were 42 males and 15 females,aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages.The other random 57 patients were assigned into a control group.They were 40 males and 17 females,aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians.The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2,6,12 and 24 weeks,and visual analogue scale(VAS)pain scores and SF36 scores at postoperative 12 and 24 weeks.Results A total of 105 patients(55 in the intervention group and 50 in the control group)were completely followed up for 151 to 254 d(mean,177 d).The 2 groups were comparable due to no significant difference between them in the preoperative general data(P>0.05).The Majeed scores(44±13,67±16,86±14 and 98±7)and Barthel indexes(57±13,79±16,95±8 and 100±2)at postoperative 2,6,12 and 24 weeks in the intervention group were significantly higher than those in the control group[(35±16,51±16,73±14 and 91±12)and(45±19,67±18,86±12 and 98±4)](all P<0.05).At postoperative 12 and 24 weeks,the SF-36 scores(129±15 and 141±6)in the intervention group were significantly higher than those in the control group(114±15 and 131±12)(P<0.05).There was no significant difference in the pain degree between the 2 groups(P

关 键 词：骨盆 骨折 加速康复外科 骨科康复 随机对照试验 

分 类 号：R687.3[医药卫生—骨科学] R493[医药卫生—外科学]