摘要
[目的]探讨老年股骨粗隆间骨折行股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)固定围术期应用加速康复(enhanced recovery after surgery,ERAS)的临床效果。[方法]80例股骨粗隆间骨折行PFNA术的患者,按围术期处理方法的不同分为加速康复组和传统康复组,每组40例。比较两组患者术后不同时间疼痛程度、并发症、髋关节Harris评分、基本生活能力评分(改良BADL量表)及住院时间的差异。[结果]加速组在术后1、12、24、72 h疼痛视觉模拟评分(VAS)明显低于传统组,差异均有统计学意义(P<0.05)。加速组术后早期并发症发生率明显低于传统组[(4/40)vs(11/40),P<0.05],差异有统计学意义;加速组住院天数明显短于常规组[(6.82±0.64)d vs(9.21±0.83)d,P<0.05],两组间差异有统计学意义。此外,加速组术后3个月时Harris评分和基本生活能力评分均高于传统组,其中Harris评分两组间差异有统计学意义(P<0.05)。[结论]老年股骨粗隆间骨折PFNA围术期中应用ERAS理念是安全可行的,不但有效地减少并发症的发生,提高术后生存质量,而且促进髋关节功能恢复、缩短住院时间。
[Objective] To explore the outcome of enhanced recovery after surgery（ERAS） in proximal femoral nail anti-rotation（PFNA） for femoral intertrochanteric fracture in the elderly [Methods] A retrospective study was performed on elderly 80 patients who underwent PFNA for femoral intertrochanteric fracture. According to the perioperative rehabilitation protocol applied, patients were divided into the ERAS group（n=40） and the conventional group（n=40）. The visual analogue scale（VAS）,Harris score and improved basic activities of daily living（BADL） scale, as well as the complications and hospitalization time were compared between the two groups. [Results] At 1, 12, 24 and 72 hours after operation, the ERAS group got statistically less VAS scores than the conventional group（P〈0.05）. Additionally, the former had significantly lower early complication rate compared to the latter [（4/40） vs（11/40）, P〈0.05]. Furthermore, the ERAS group spend considerably shorter hospital stay than the conventional group [（6.82 ± 0.64） d vs（9.21 ± 0.83） d, P〈0.05]. Moreover, the ERAS group was ranked higher Harris and BADL scores than the conventional group at 3 months postoperatively, although only a significant difference in Harris score was noticed between them（P〈0.05）. [Conclusion] Enhanced recovery after surgery in PFNA for femoral intertrochanteric fracture in the elderly is a safe and feasible protocol, which can effectively reduce the incidence of complications, improve the postoperative quality of life, promote the recovery of hip function and shorten the hospitalization.
作者
万安营
唐淼
WAN An-ying;TANG Miao(Department of Orthopaedics, Suzhou Affiliated Hospital of Anhui Medical University, Suzhou 234000, Chin)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第10期888-892,共5页
Orthopedic Journal of China
关键词
加速康复
粗隆间骨折
股骨近端防旋髓内钉
老年
enhanced rehabilitation
femoral intertrochanterie fracture
proximal femoral nail anti-rotation （PFNA）
elderly
