日间全髋关节置换术的短期随访研究  

Short-term clinical outcomes of outpatient total hip arthroplasty

作　　者：刘安[1] 李丛笋 杨伟男 陆斐 金爱东[1] 吴浩波[1] 严世贵[1] Liu An;Li Congsun;Yang Weinan;Lu Fei;Jin Aidong;Wu Haobo;Yan Shigui(Department of Orthopaedics,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2022年第9期563-569,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨日间全髋关节置换术(total hip arthroplasty,THA)治疗髋关节骨关节病的安全性、经济学效应及短期临床疗效。方法回顾性分析2020年7月至2021年7月接受48 h出院的日间初次THA手术的患者75例(日间组),根据年龄和性别按1∶1的比例匹配75例在相同时间段内接受常规初次THA的患者(常规组)。比较两组患者的性别、年龄、体质指数(body mass index,BMI)、诊断、居住地、住院时间、手术时间、术前及术后第1天血红蛋白、白蛋白、C反应蛋白(C reactive protein,CRP)、D-二聚体、术后第2天视觉模拟评分(visual analogue scale,VAS)、术前及术后1个月髋关节改良Harris评分、术后1个月再入院及再手术情况。结果两组患者年龄、性别、BMI、诊断、术前髋关节改良Harris评分的差异无统计学意义(P>0.05);日间组患者均来自于浙江省内且杭州市内比例高(48%,36/75),常规组有6例患者来自外地,两组患者居住地的差异有统计学意义(χ^(2)=6.29,P=0.043)。日间组住院时间为(2.13±0.52)d,较常规组的(6.71±1.44)d缩短(t=25.91,P<0.001);手术时间为(59.73±18.91)min,较常规组的(66.91±22.40)min缩短(t=2.12,P=0.036);平均住院费用为(4.60±0.44)万元,较常规组的(5.20±0.72)万元较少(t=6.16,P<0.001);术后第2天VAS评分为(3.45±0.75)分,较常规组的(3.16±0.94)分高(t=2.09,P=0.039)。日间组与常规组术后1个月改良Harris评分的差异无统计学意义(t=0.42,P=0.677)。日间组有7例延迟出院(未能在48 h内出院),延迟出院率为9.3%,原因包括疼痛控制不佳2例、术后恶心呕吐1例、康复不达标1例、术后持续低血压1例、术中发现感染1例、术后48 h内发热1例。结论日间THA可减少住院时间、手术时间及住院总费用,具有与常规THA相似的安全性及早期临床疗效,但部分患者会延迟出院。Objective To investigate the safety,economic effect,and short-term clinical efficacy of ambulatory total hip arthroplasty(THA)in the treatment of hip osteopathy within.Methods This study retrospectively reviewed patients who underwent 48-hour outpatient THA and conventional primary THA from July 2020 to July 2021.Gender,age,body mass index(BMI),clinical diagnosis,place of resident,length of hospital stay,duration of the surgery,hemoglobin,albumin,C-reactive protein(CRP)and D-dimer before and 1 day after surgery,the visual analogue scale(VAS)was obtained postoperative day 2,hip joint modified Harris score before and 1 month after surgery,readmission and reoperation within 1 month after operation as the data of evaluations were extracted and compared in this study.Results A totally of 150 cases were involved in this study,which including 75 cases with 48-hour outpatient primary THA and 75 cases with conventional primary THA.There was no significant difference between the two groups in terms of age,sex,BMI,education level,preoperative diagnosis,and preoperative Harris score(P>0.05),but a significant difference was found in term of residence(χ^(2)=6.29,P=0.043),that the patients in the outpatient group were all from Zhejiang Province and 48%(36/75)of them were from Hangzhou City.While,in the conventional group,6 patients were from other provinces.The length of stay was 2.13±0.52 days and operation time was 59.73±18.91 minutes in the outpatient group,which were both shorter than those(6.71±1.44 days and 66.91±22.40 min)in the conventional group(t=25.91,P<0.001 for the length of hospital stay;t=2.12,P=0.036 for operation time).Compared with the conventional group,outpatient group saved the average hospital cost(4.60±0.44 vs.5.20±0.72 ten thousand yuan,t=6.16,P<0.001).The VAS on the second day after surgery 3.45±0.75 was higher in the outpatient group than in the conventional group(3.45±0.75 vs.3.16±0.94 points,t=2.09,P=0.039).The modified Harris score was without statistical significance(t=0.42,P=0.677)1 mont

关 键 词：关节成形术 置换 髋 门诊外科手术 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]