多学科诊疗加速康复外科模式在老年骨质疏松性踝关节骨折治疗中的应用  

Multi-disciplinary treatment combined with enhanced recovery after surgery for elderly patients with osteoporotic ankle fracture

作　　者：吴天一 吴承霖 陈亦轩 刘畅 唐明杰[1] 王挺[1] 王磊[1] 施忠民[1] 马昕[1] Wu Tianyi;Wu Chenglin;Chen Yixuan;Liu Chang;Tang Mingjie;Wang Ting;Wang Lei;Shi Zhongmin;Ma Xin(Department of Orthopaedics,Shanghai Sixth People's Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院骨科,上海200233

出　　处：《中华创伤骨科杂志》2025年第1期57-63,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探究多学科诊疗(MDT)加速康复外科(ERAS)模式用于老年骨质疏松性踝关节骨折的价值。方法回顾性分析2021年1月至2024年1月上海交通大学医学院附属第六人民医院足踝外科采用MDT ERAS模式与非MDT模式治疗的88例老年骨质疏松性踝关节骨折患者资料。按照是否采用MDT ERAS模式分为MDT组和匹配组(1∶1配比),每组44例。比较两组患者围手术期的固定选择、住院时间、重返工作或日常生活的时间、住院期间的患者满意度量表(PSQ-18)、并发症的发生率,以及术后1、3个月的踝关节活动度、美国足踝外科协会(AOFAS)踝-后足评分、疼痛视觉模拟评分(VAS)、步行状态。结果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。MDT组患者围手术期的固定选择、PSQ-18[(78.4±8.5)分]、术后3个月时的AOFAS踝-后足评分[(75.4±8.2)分]和步行状态均显著优于匹配组[(74.2±9.6)分、(70.9±9.4)分],差异均有统计学意义(P<0.05)。两组患者的住院时间和重返工作或日常生活时间比较差异均无统计学意义(P>0.05)。术后1、3个月两组患者间踝关节背屈及跖屈活动度、疼痛VAS评分、并发症发生率比较,以及术后1个月AOFAS踝-后足评分、步行状态比较,差异均无统计学意义(P>0.05)。结论MDT ERAS模式可有效改善老年骨质疏松性踝关节骨折疗效和患肢功能,提高患者满意度。ObjectiveTo evaluate the clinical value of multi-disciplinary treatment(MDT)combined with enhanced recovery after surgery(ERAS)for the elderly patients with osteoporotic ankle fracture.MethodsA retrospective analysis was conducted to analyze the 88 elderly patients with osteoporotic ankle fracture who had been treated with MDT combined with ERAS or non-MDT at Department of Foot and Ankle Surgery,Shanghai Sixth People's Hospital from January 2021 to January 2024.According to whether MDT was adopted or not,this cohort was assigned into 2 groups using the propensity score matching method:a MDT group and a non-MDT group with a matching ratio of 1∶1(44 cases per group).The 2 groups were compared in terms of choice of intraoperative fixation,hospital stay,time for return to work/daily life,patient satisfaction questionnaire(PSQ-18)during hospitalization,ankle range of motion at 1 and 3 months after surgery,ankle-hindfoot score of American Orthopaedic Foot and Ankle Society(AOFAS),visual analogue scale(VAS)for pain,gait,and incidence of complications.ResultsThere were no significant differences in the preoperative general data between the 2 groups,indicating comparability(P<0.05).The choice of intraoperative fixation,PSQ-18[(78.4±8.5)points],AOFAS ankle-hindfoot score at 3 months after operation[(75.4±8.2)points],and gait in the MDT group were significantly better than those in the non-MDT group[(74.2±9.6)points and(70.9±9.4)points](P<0.05).There was no significant difference in the hospital stay or time for return to work/daily life between the 2 groups(P>0.05).There was no statistically significant difference either in ankle dorsiflexion or plantarflexion,VAS for pain,or incidence of complications between the 2 groups at 1 or 3 months after surgery,as well as in AOFAS ankle-hindfoot score or gait at 1 month after surgery(P>0.05).ConclusionMDT combined with ERAS can effectively increase the therapeutic efficacy for the elderly patients with osteoporotic ankle fracture,improve their function of affected limbs,and

关 键 词：骨折 康复 骨质疏松 多学科诊疗模式 倾向评分匹配 治疗效果 

分 类 号：R687.3[医药卫生—骨科学]