加速康复外科综合治疗在三角纤维软骨复合体损伤患者围术期中的应用  

Application of enhanced recovery after surgery comprehensive treatment in the perioperative period of patients with triangular fibrocartilage complex injuries

作　　者：马志虎 于晓凤 孙玉亮 王刚[1] 裴艳涛[1] 陈斌 史安浩 乔丽[1] 朱磊[1] MA Zhihu;YU Xiaofeng;SUN Yuliang;WANG Gang;PEI Yantao;CHEN Bin;SHI Anhao;QIAO Li;ZHU Lei(Department of Orthopedics,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院骨科,山东济南250012

出　　处：《山东大学学报(医学版)》2025年第3期28-35,共8页Journal of Shandong University:Health Sciences

摘　　要：目的 观察加速康复外科(enhanced recovery after surgery, ERAS)综合治疗对三角纤维软骨复合体(triangular fibrocartilage complex, TFCC)损伤经腕关节镜修复术后患者围术期的效果。方法 回顾性收集山东大学齐鲁医院2023年1月至12月行腕关节镜下修复TFCC损伤患者46例,行ERAS综合康复患者为观察组,常规康复患者为对照组,每组23例。观察组和对照组术后均采用同一种支具外固定方式,前3周采用过肘关节支具,3周根据复查情况更换前臂外固定支具,6周后根据复查情况去除外固定支具逐渐恢复康复训练,其中对照组根据术前谈话及复查医嘱自行行康复锻炼。观察组术前即开始通过预康复运动、营养、心理治疗,综合评估,制定患者个性化综合护理计划,术后采用早期渐进式康复治疗,进行肌肉训练、关节活动、理疗、日常生活训练等,过程中由护理人员监督指导完成。术后6周和12周分别对患者疼痛视觉模拟量表(visual analogue scale, VAS)进行评分,术后12周评估关节活动度及改良的MAYO腕关节评分。结果 观察组术后6、12周疼痛VAS评分均较对照组低,术后12周腕关节背伸、掌屈、桡偏、尺偏活动度、MAYO腕关节评分均较对照组高,差异有统计学意义(P<0.05)。结论 ERAS理念应用于TFCC损伤患者能够缩短康复治疗时间,提高康复效果,对手术的疗效起到强化作用,助力患者尽快回归社会生活。Objective To observe the perioperative efficacy of the comprehensive treatment of enhanced recovery after surgery(ERAS)in patients with triangular fibrocartilage complex(TFCC)injury after undergoing transcarpal arthroscopic repair.Methods A retrospective collection was carried out on 46 patients with TFCC injuries who underwent transcarpal arthroscopic repair in Qilu Hospital of Shandong University from January to December 2023.The patients who underwent ERAS comprehensive rehabilitation were assigned to the observation group,and those who received conventional rehabilitation were designated as the control group,with 23 cases in each group.Both the observation group and the control group were treated with the same modality of external orthotic fixation postoperatively.In the initial three-week period,an above-elbow orthosis was applied.Subsequently,at the three-week mark,a review was conducted and,based on the assessment,the forearm external fixation orthosis was substituted.After six weeks,in accordance with the reevaluation findings,the external fixation orthosis was removed and a progressive resumption of rehabilitation training was initiated.Among them,the control group carried out rehabilitation exercises on their own according to the preoperative conversation and the doctor's advice during the review.In the observation group,pre-rehabilitation exercises,nutritional support,and psychological counseling were initiated prior to surgery,followed by a comprehensive evaluation.Subsequently,a comprehensive assessment was conducted to develop an individualized comprehensive nursing plan for the patients.After the operation,an early progressive rehabilitation treatment was adopted,which comprised muscle training,joint mobilization,physiotherapy,and activities of daily living training.The entire process was supervised and directed by nursing staff until completion.The visual analogue scale(VAS)for pain was scored at 6 and 12 weeks postoperatively,and the range of joint motion and the modified MAYO wrist score were ev

关 键 词：加速康复外科 三角纤维软骨复合体损伤 预康复 早期康复 腕关节镜 

分 类 号：R68[医药卫生—骨科学]