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中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (01) : 10 -17. doi: 10.3877/cma.j.issn.2096-0263.2022.01.003

髋部骨折

加速康复外科理念在高龄髋部骨折围术期的应用效果
石文俊1, 商培洋1, 成翔宇1, 石继祥1, 刘孚瑛1, 庞金辉1, 张磊1, 章筛林1,()   
  1. 1. 200062 上海中医药大学附属普陀医院骨科
  • 收稿日期:2019-03-15 出版日期:2022-02-05
  • 通信作者: 章筛林
  • 基金资助:
    上海市普陀区卫生系统自主创新项目(2013PTKW015)

Enhanced recovery after surgery for elderly patients with hip fracture during the perioperative period

Wenjun Shi1, Peiyang Shang1, Xiangyu Cheng1, Jixiang Shi1, Fuying Liu1, Jinhui Pang1, Lei Zhang1, Shailin Zhang1,()   

  1. 1. Department of Orthopaedics, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
  • Received:2019-03-15 Published:2022-02-05
  • Corresponding author: Shailin Zhang
引用本文:

石文俊, 商培洋, 成翔宇, 石继祥, 刘孚瑛, 庞金辉, 张磊, 章筛林. 加速康复外科理念在高龄髋部骨折围术期的应用效果[J/OL]. 中华老年骨科与康复电子杂志, 2022, 08(01): 10-17.

Wenjun Shi, Peiyang Shang, Xiangyu Cheng, Jixiang Shi, Fuying Liu, Jinhui Pang, Lei Zhang, Shailin Zhang. Enhanced recovery after surgery for elderly patients with hip fracture during the perioperative period[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(01): 10-17.

目的

探讨加速康复外科(ERAS)理念在高龄髋部骨折患者围术期应用的临床效果。

方法

回顾性分析2013年7月至2016年10月,上海中医药大学附属普陀医院接受手术的高龄(年龄≥75岁)髋部骨折患者149例,男62例,女87例,年龄(82±5)岁。分别采用加速康复外科组及传统处理模式组进行围手术期处理。分析两组患者术后住院时间、疼痛视觉模拟评分(VAS)评分、术后并发症发生情况、髋关节Harris评分并进行对比。

结果

149例患者均成功获得随访,随访时间(16.0±2.3)个月。男62例,女87例,平均年龄(82±5)岁。加速康复外科组患者术后住院时间为(7.2±1.2)d,少于传统处理模式组术后住院时间[(12.1±1.9)d,t=2.513,P<0.05]。术后24 h及48 h,加速康复外科组VAS评分与传统处理模式组比较,差异无统计学意义(t=1.761,t=1.598;均P>0.05)。术后12 h及72 h,加速康复外科组VAS评分为(2.5±1.3)分、(1.2±0.8)分,低于传统处理模式组[(3.9±1.6)分、(2.7±1.5)分,t=2.379,t=2.165;均P<0.05]。加速康复外科组术后精神异常以及恶心呕吐发生率(6.4%及9.0%)低于传统处理模式组(23.9%及29.6%,χ2=9.079,χ2=10.339;均P<0.05)。肺部感染、下肢深静脉血栓、脑血管意外、尿路感染、褥疮发生率差异无统计学意义(χ2=1.665,χ2=1.232,χ2=0.444,χ2=2.170及χ2=1.091;均P>0.05)。术后1 w,加速康复外科组Harris评分为(63.2±4.8)分,高于传统处理模式组[(49.2±3.9)分,t=2.221,P<0.05],术后3、6及12个月,两组Harris评分差异无统计学意义(t=1.187,t=1.098,t=0.813,均P>0.05)。

结论

高龄髋部骨折患者围手术期应用加速康复外科理念安全有效,可以减少术后精神异常以及恶心呕吐发生率,加速患者术后早期髋关节功能恢复,缩短术后住院时间,值得临床推广应用。

Objective

To evaluate the clinical effects of enhanced recovery after surgery (ERAS) forelderly patients with hip fracture during the perioperative period.

Methods

149 elderly patients (≥75 years old) with hip fracture who underwentsurgery were analyzed retrospectivelyfrom July 2013 to October 2016 in Putuo Hospital affiliated to Shanghai University of Chinese Medicine. There were 62 males and 87 females with mean age of 82±5 years. All patients were divided into ERAS group (78 cases) and conventional care group (71 cases) during the perioperative period. The length of postoperative hospital stay, Visualanalogyscore (VAS), postoperative complications and Harris hip score of the two groups were analyzed and compared.

Results

All 149 patients werefollowed up with an average of 1 (6.0±2.3) months. The length of postoperative hospital stay was (7.2±1.2) day in ERAS group and (12.1±1.9) day in conventional care group, (t=2.513, P<0.05). Therewasno significant difference in VAS score between the two groups at 24 h and 48 h after surgery (t=1.761, t=1.598, P>0.05). VAS score of ERAS group at 12 h and 72 h after surgery (2.5±1.3 and 1.2±0.8) was significantly lower than that of conventional care group (3.9±1.6 and 2.7±1.5)(t=2.379, t=2.165, P<0.05)]. Postoperative complication rates of mental disorder andincidence of nausea and vomiting in ERAS group (6.4% and 9.0% respectively) were significantly lower than conventional care group (23.9% and 29.6%) (χ2=9.079, χ2=10.339, P<0.05). There were no significant differences in the rates of pneumonia, DVT, cerebrovascular accident, urinary tract infection and bedsore between two groups (χ2=1.665, χ2=1.232, χ2=0.444, χ2=2.170, χ2=1.091, P>0.05). Harris hip score of ERAS group (63.2±4.8) was significantly higher than than conventional care group (49.2±3.9) (t=2.221, P<0.05) at 1 week after surgery. There was no significant difference in Harris hip score between the two groups at 3 months, 6 months and 12 months after surgery (t=1.187, t=1.098, t=0.813, P>0.05).

Conclusions

The application of ERAS program for elderly patients with hip fracture during the perioperative period can reduce the complication rates of mental disorder and the incidence of nausea and vomiting, accelerate the recovery of the early postoperative hip function and shorten the length of postoperative hospital stay.

表1 两组高龄髋部骨折患者术前一般资料
图1~4 一例加速康复外科组患者术前及术中影像资料。女性,83岁,术前X线提示左股骨粗隆间骨折。图1术前X线;图2术中C臂机透视、牵引床辅助下闭合复位内固定;图3术中透视见正位片骨折断端复位满意;图4术中透视见侧位片骨折断端复位满意
图5~7 一例加速康复外科组患者术后康复训练及术后影像资料。图5术后当天行左下肢肌肉等长收缩训练;图6术后第2天左髋关节X线片;图7术后随访18个月复查左髋关节X线片
表2 两组高龄髋部骨折患者术后不同时间点VAS评分比较(分,±s
图8~10 一例加速康复外科组患者术后并发尿路感染的影像资料。女性,85岁,右股骨粗隆间骨折。图8术前X线;图9术前髋关节三维CT示右股骨粗隆间骨折;图10术后第2天复查右髋关节X线片
表3 两组高龄髋部骨折术后并发症患者的一般资料及髋关节Harris评分
表4 两组高龄髋部骨折患者术后并发症比较(例)
表5 两组高龄髋部骨折患者术后髋关节Harris评分(分,±s
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