加速康复外科在老年全髋关节置换术中的应用分析  

Analysis of the application effect of enhanced recovery after surgery in elderly total hip arthroplasty

作　　者：吉叶芝 何维栋[2] 任西宁 JI Ye-zhi;HE Wei-dong;REN Xi-ning(Department of Orthopedics,Lianyungang First People's Hospital,Jiangsu,Lianyungang,222000,China)

机构地区：[1]连云港市第一人民医院骨科,江苏省222000 [2]连云港市第一人民医院关节外科,江苏省222000

出　　处：《中国骨与关节杂志》2025年第1期41-46,共6页Chinese Journal of Bone and Joint

摘　　要：目的分析加速康复外科(enhanced recovery after surgery,ERAS)在老年全髋关节置换术(total hip arthroplasty,THA)患者中的应用效果。方法选取我院2023年1月至2024年2月收治的130例老年THA患者,根据随机数字表法分为ERAS组和对照组,每组各65例,其中男40例,女90例;年龄60~87岁,平均(73.44±5.91)岁。评估两组患者围术期指标(手术时间、术中失血量、离床时间、住院时间、术后并发症)、髋部功能[髋关节活动范围,起立-行走计时测试(timed up and go test,TUGT)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)、哈里斯髋关节评分(Harris hip score,HHS)]、疼痛程度[数字评分量表(numerical rating scale,NRS)]及生活质量[36项健康调查简表(36-item short form,SF-36)]。结果ERAS组手术时间、术中失血量、离床时间和住院时间均低于对照组(P<0.05)。ERAS组术后总并发症发生率低于对照组(9.2%vs.26.2%,P=0.011)。术后1周、1个月时,ERAS组TUGT和WOMAC低于对照组(P<0.05),髋关节活动范围和HHS高于对照组(P<0.05)。术后1周、1个月以及3个月时,ERAS组休息期和活动期的NRS低于对照组(P<0.05)。术后3个月时,ERAS组SF-36各维度得分高于对照组(P<0.05)。结论ERAS方案能优化老年THA患者围术期指标,降低术后并发症发生率,早期改善髋部功能,减轻术后疼痛程度,提高生活质量,加速患者康复。Objective To analyze the effect of enhanced recovery after surgery(ERAS)in elderly Total Hip Arthroplasty(THA)patients.Methods 130 cases of elderly THA admitted to our hospital from January 2023 to February 2024 were selected and divided into ERAS group and control group according to randomized numerical table method,and each group consisted of 65 cases.There were 40 males and 90 females,and their ages ranged from 60 to 87 years(mean,73.44±5.91 years).Perioperative indicators(operation time,intraoperative blood loss,out of bed time,hospitalization,postoperative complications)and hip functions[hip range of motion,timed up and go test(TUGT),Western Ontario and McMaster Universities Osteoarthritis Index(WOOI)]were evaluated in both groups.McMaster Universities Osteoarthritis Index(WOMAC),Harris hip score(HHS),pain level(numerical rating scale,NRS),and quality of life(36-item short form,SF-36)were analyzed.Results The operation time,intraoperative blood loss,time out of bed and hospitalization time were lower in the ERAS group than in the control group(P<0.05).The total postoperative complication rate was lower in the ERAS group than in the control group(9.2%vs.26.2%,P=0.011).At 1 week and 1 month postoperatively,TUGT and WOMAC were lower in the ERAS group than in the control group(P<0.05),and hip range of motion and HHS were higher than that in the control group(P<0.05).At 1 week,1 month,and 3 months postoperatively,the NRS in the ERAS group was lower than that in the control group during the rest and activity periods(P<0.05).At 3 months postoperatively,patients in the ERAS group had higher SF-36 scores on all dimensions than patients in the control group(P<0.05).Conclusions The ERAS protocol optimizes the perioperative indexes of elderly THA patients,reduces postoperative complications,improves hip function at an early stage,reduces the degree of postoperative pain,improves the quality of life,and acceleratespatient recovery.

关 键 词：术后加速康复 髋骨折 关节成形术 置换 髋 

分 类 号：R687.3[医药卫生—骨科学]