加速康复外科理念在高龄股骨转子间骨折围手术期应用的临床疗效研究

目的观察和评价加速康复外科理念在高龄股骨转子间骨折围手术期应用的临床疗效。方法采用前瞻性研究方法,选取2017年4月至2019年2月首都医科大学附属北京友谊医院收治的高龄股骨转子间骨折患者78例,按照单纯随机抽样法平均分为对照组和加速康复组,每组各39例。所有患者均接受骨折闭合复位带锁髓内钉手术治疗,对照组采用传统的围手术期管理,而加速康复组将加速康复理念应用到围手术期管理中。记录所有患者的一般情况、平均住院时间、围手术期输血率、术后48 h疼痛视觉模拟评分(VAS)、术后并发症情况、术后2周满意度评分以及术后6个月髋关节Harris评分。结果术后随访5.8~7.5个月,平均随访(7.3±1.2)个月,除5例患者失访外73例患者均完成随访,其中对照组36例,加速康复组37例。对照组患者的平均住院时间、围手术期输血率、术后2周满意度评分、术后48 h疼痛VAS、术后并发症发生率分别为(9.3±1.8) d、13.8%(5/36)、(7.3±0.8)分、(4.1±1.3)分和19.4%(7/36)加速康复组上述指标分别为(7.6±1.4)d、8.1%(3/37)、(9.1±1.1)分、(6.8±1.7)分和13.5%(5/37),两组比较差异均具有统计学意义(P <0.05)。术后6个月,对照组患者的Harris评分为(75.8±4.1)分,加速康复组为(76.1±4.3)分,两组比较,差异无统计学意义(P>0.05)。结论加速康复理念在老年股骨转子间骨折围手术期的应用可以提高患者满意度,缩短平均住院时间,减少术后并发症发生,有利于患者在术后快速康复。

Clinical efficacy of the concept of enhanced recovery after surgery in treatment of aged femoral intertrochanteric fractures patients during perioperative period

Objective To investigate and evaluate the efficacy of the application of enhanced recovery after surgery(ERAS) in treatment of aged femoral intertrochanteric fractures patients during perioperative period.Methods The prospective study was conducted.78 elderly patients who were diagnosed as femoral intertrochanteric fractures were selected at Beijing Friendship Hospital,Capital Medical University from April2017 to February 2019,while all the patients were divided into control group and ERAS group on average according to simple random sampling method,39 cases in each group.All the patients were treated with closed reduction and intramedullary nail fixation.The patients in control group were treated with traditional perioperative management,while the patients in ERAS group were treated with the fast track rehabilitation program.Generation conditions,average hospitalization time,perioperative blood transfusion rate,VAS at 48 h after operation,postoperative complication,degree of satisfaction at 2 weeks after operation and postoperative Harris hip score at six months after operation were recorded for all patients.Results Seventy-three patients were followed up except five patients lost.Seventy-three patients including thirty-six of control group and thirty-seven of ERAS group were followed for 5.8~7.5 months,average(7.3±1.2) months.Average hospitalization time,perioperative blood transfusion rate,VAS at 48 h after operation,incidence of postoperative complication in control group were(9.3±1.8) d,13.8%(5/36),7.3±0.8,4.1±1.3 and 19.4(7/36),while the indexes in ERAS group were(7.6±1.4) d,8.1%(3/37),9.1±1.1,6.8±1.7,13.5(5/37).The differences of the above indexes were statistically significant between the two groups(P <0.05).Harris hip score at six months after operation was 75.8±4.1 in control group and 76.1±4.3 in ERAS group respectively,while there was no statistically significant difference between two groups(P> 0.05).Conclusion The application of ERAS on aged femoral intertrochanteric fractures patients during perioperative period can improve satisfaction of patients,shorten hospitalization time and reduce postoperative complications,and it is helpful for aged femoral intertrochanteric fractures patients to recover rapidly.