加速康复外科联合综合康复治疗在防治腹部带蒂皮瓣修复术后继发冻结肩中的应用  

Application of enhanced recovery after surgery combined with comprehensive rehabilitation in prevention and treatment of secondary frozen shoulder after pedicled flap repair

作　　者：王德明 温宝磊 费圣强 储艳 孙乐天 姜凯 曲彦亮 WANG Deming;WEN Baolei;FEI Shengqiang;CHU Yan;SUN Letian;JIANG Kai;QU Yanliang(Hand Surgery Center,the 971st Hospital of the Navy,Qingdao 266071,Shandong,China)

机构地区：[1]海军第971医院全军手外科中心,山东青岛266071

出　　处：《中华骨与关节外科杂志》2022年第2期105-110,共6页Chinese Journal of Bone and Joint Surgery

基　　金：山东省医药卫生科技发展计划项目(2016WS0726)。

摘　　要：目的:探讨加速康复外科(ERAS)联合综合康复治疗在预治腹部带蒂皮瓣修复术后继发冻结肩中的应用。方法:回顾性纳入2016年6月至2018年12月收治的68例采用腹部带蒂皮瓣一期修复手、前臂皮肤缺损的术后患者。根据二期腹部皮瓣断蒂术围手术期干预方式不同分为联合治疗组36例和单纯手术组32例。联合治疗组在ERAS理念下进行腹部皮瓣断蒂术联合综合康复治疗,即肩关节松动术+术后多模式镇痛+主动康复训练;单纯手术组仅采用腹部皮瓣断蒂术治疗,围手术期采取常规处理。两组均采用臂丛神经阻滞联合硬膜外麻醉。比较两组术中、术后不同时间警觉/镇静评分(OAA/S)、视觉模拟评分(VAS)、加州大学肩关节评分(UCLASS)及肩关节活动度。结果:两组切皮时、切皮后30 min、术毕时的心率(HR)、平均动脉压(MAP)、OAA/S评分比较,差异有统计学意义(P<0.05);联合治疗组术后第1次主动功能锻炼时的VAS评分低于单纯手术组(P<0.05),术后2周的UCLASS评分高于单纯手术组(P<0.01),临床治愈率、显效率明显优于单纯手术组(P<0.05)。结论:ERAS联合综合康复治疗可以有效防治腹部带蒂皮瓣修复术后继发冻结肩,促进患者手及肩关节功能的全面恢复,提高患者整体疗效,值得临床医师借鉴。Objective: To investigate the effect of enhanced recovery after surgery(ERAS) combined with comprehensive rehabilitation in the prevention and treatment of frozen shoulder induced by pedicled flap repair. Methods: From June 2016 to December 2018,68 patients with skin defect of hand, wrist or forearm repaired by abdominal pedicled flap were enrolled in the study. According to the different intervention methods, patients were divided into combined treatment group(n=36) and operation group(n=32). Under the concept of ERAS, patients in the combined treatment group were treated by abdominal flap pedicle division combined with comprehensive rehabilitation, that is, shoulder joint mobilization+postoperative multi-mode analgesia+active rehabilitation training;patients in the operation group were only treated by abdominal flap pedicle division.Both groups were treated with brachial plexus and epidural anesthesia. The scores of OAA/S, VAS, UCLASS and shoulder mobility were compared between the two groups. Results: At the beginning of operation, 30 minutes after operation and at the end of operation,there were significant differences in heart rate, mean arterial pressure and OAA/S between the two groups(P<0.05). At the first active functional exercise after operation, VAS in the combined treatment group was significantly lower than that in the operation group(P<0.05). The scores of UCLASS was higher in the combined treatment group than in the single operation group 2 weeks after operation(P<0.01);the clinical cure rate and effective rate were significantly better in the combined treatment group than in the single operation group(P<0.05). Conclusions: ERAS combined with comprehensive rehabilitation can prevent and treat frozen shoulder induced by pedicled flap repair, promote the comprehensive recovery of hand and shoulder joint function, reduce postoperative pain and improve the overall effect of patients, which is worthy of reference for clinicians.

关 键 词：加速康复外科 带蒂皮瓣修复 继发性冻结肩 综合康复治疗 

分 类 号：R687.2[医药卫生—骨科学]