人工全膝关节置换术结合加速康复外科理念治疗膝关节骨关节炎的临床效果

探讨人工全膝关节置换术(TKA)结合加速康复外科(ERAS)理念治疗膝关节骨关节炎(KOA)的疗效。 方法选取赤峰市医院骨关节科2018年1月至11月收治的KOA患者220例，按随机数字表法分为2组，加速康复组(n＝108)，遵循围手术期应用ERAS理念，严格执行加速康复程序；对照组(n＝112)，沿袭传统手术管理模式。制定相同的出院标准，比较2组患者术后早期疼痛数字评分法(NRS)评分，术后输血率，恶心、呕吐发生率，口渴、饥饿发生率，达到出院标准的时间，术后2周的满意度评分，术后3个月美国特种外科医院(HSS)膝关节评分，术后并发症发生率等。数据比较采用t检验和χ²检验。 结果术后12、24、48 h,加速康复组术后早期疼痛NRS评分分别为(2.13±1.21)、(2.42±1.11)、(2.83±1.18)分，低于对照组[(3.24±1.45)、(3.35±1.23)、(3.78±1.25)分]，差异均有统计学意义(t＝3.9498、3.7689、3.7088，P＝0.0002、0.0003、0.0004)；加速康复组术后输血率6.5%(7/108)，低于对照组[27.7%(31/112)]，差异有统计学意义(χ²＝17.2887，P<0.05)；加速康复组术后恶心、呕吐发生率为14.8%(16/108)，低于对照组[38.4%(43/112)]，差异有统计学意义(χ²＝15.5741，P<0.05)；加速康复组术后口渴、饥饿发生率为12.0%(13/108)，低于对照组[41.1%(46/112)]，差异有统计学意义(χ²＝23.6163，P<0.05)；加速康复组达到出院标准的时间平均为(2.9±1.3) d，少于对照组[(5.7±1.6) d]，差异有统计学意义(t＝9.1301，P<0.05)；加速康复组术后2周的满意度评分为(9.8±1.2)分，高于对照组[(8.9±1.1)分]，差异有统计学意义(t＝3.7042，P<0.05)；加速康复组、对照组术后3个月HSS膝关节评分分别为(88.2±13.2)、(87.7±16.6)分，2组比较差异无统计学意义(t＝0.1585，P＝0.8744)；加速康复组并发症发生率为2.7%(3/108)，低于对照组[9.8%(10/112)]，差异有统计学意义(t＝4.5779，P＝0.0324)。 结论采用人工TKA结合ERAS理念治疗KOA，可以减轻术后应激反应，加速患者康复进程，减少手术并发症，缩短住院时间，提高患者满意度，是一种安全、可靠的选择，值得临床推广应用。

Clinical effect of total knee arthroplasty combined with enhanced recovery after surgery on knee osteoarthritis

ObjectiveTo evaluate the effect of total knee arthroplasty (TKA) combined with enhanced recovery after surgery (ERAS) in knee osteoarthritis (KOA). MethodsTwo hundred and twenty patients with KOA of the Department of Joint Surgery, Chifeng Municipal Hospital from January 2018 to November 2018 were divided into enhanced recovery group and control group according to the random number table method. The enhanced recovery group(n=108)was applied the ERAS concept and strictly implemented the enhanced recovery program. In contrast group, conventional surgical management mode was followed.Identical discharge standards were established for patients in two groups to evaluate the recovery time.The early postoperative pain numerical rating scale(NRS), blood transfusion rate, nausea and vomiting incidence, thirst, hunger and abdominal distension incidence rate, the time of discharge, the satisfaction of 2 weeks after operation, 3 months′ Hospital for special surgery(HSS) knee score after operation, and the incidence of postoperative complications were compared between the two groups. The data were analyzed by t test and chi-square test. ResultsAt 12, 24, and 48 h after operation, the NRS score of patients in the enhanced recovery group were (2.13±1.21), (2.42±1.11), (2.83±1.18) points, which were lower than those in the control group[(3.24±1.45), (3.35±1.23), (3.78±1.25) points], the differences were statistically significant(t=3.9498, 3.7689, 3.7088; P=0.0002, 0.0003, 0.0004); postoperative blood transfusion rate was 6.5%(7/108) in the enhanced recovery group, it was considerably lower than the 27.7%(31/112) in control group, the difference was statistically significant(χ²=17.2887, P<0.05). The incidence of postoperative nausea and vomiting was 14.8%(16/108)in the enhanced recovery group, which was lower than that in the control group[38.4%(43/112)], the difference was statistically significant(χ²=15.5741, P<0.05). The rate of thirst and hunger in the enhanced recovery group was 12.0%(13/108), which was lower than that in the control group[41.1%(46/112)], the difference was statistically significant(χ²=23.6163, P<0.05). The average time for the enhanced recovery group to reach the discharge standard was (2.9±1.3) days, which was shorter than that of the control group[(5.7±1.6) days]. The difference was statistically significant(t=9.1301, P<0.05). The patients′ satisfaction degree at 2 weeks after operation in the enhanced recovery group was(9.8±1.2) points, which was higher than that of the control group[(8.9±1.1) points], the difference was statistically significant(t=3.7042, P<0.05). The HSS knee scores were (88.2±13.2), (87.7±16.6) points in the enhanced recovery group and control group at 3 months postoperatively, there was no significant difference between the two groups(t=0.1585, P=0.8744). The incidence of complications in the enhanced recovery group was 2.7% (3/108), which was lower than that in the control group[9.8% (10/112)], the difference was statistically significant(t=4.5779, P=0.0324). ConclusionsERAS in osteoarthritis of knee joint patients with TKA can reducing postoperative stress reaction, accelerate the recovery process of patients, reducing postoperative complications, shorten the lenth of hospital stay and effectively enhance the degree of satisfaction of the patients. It′s a safe and reliable choice and worthy to popularization and application in clinical.