摘要
目的探讨快速康复外科理念在老年股骨粗隆间骨折治疗中的应用效果。方法采取回顾性病例对照研究分析治疗的老年股骨粗隆间骨折68例,均为单侧新鲜骨折行PFNA内固定术。将患者按随机数字表分为传统康复组(TRG组)和加速康复组(ERAS组)各34例。TRG组进行传统模式治疗,ERAS组遵循围手术期循证医学证据,术前、术中和术后严格执行快速康复程序。比较两组手术时长、术中失血量、输血率、术后引流量、术后并发症的发生率、术后疼痛视觉模拟评分(VAS)及术后髋关节功能HARRIS评分、总住院时间、总治疗费用的差异。结果ERAS组总住院时间(9.6±0.3)D、治疗费用(3.23±0.34)万元均低于TRG组(15.3±2.0)D、(3.86±0.81)万元(P<0.001);在术中失血量、术后引流量、输血率方面,ERAS组分别为(202.1±57.0)ML、(32.51±2.53)ML、11.8%,均低于TRG组(260.3±75.2)ML、(89.45±4.02)ML、38.2%(P<0.001);ERAS组术后恶心、呕吐以及口渴、饥饿、腹胀的发生率分别为8.8%和17.6%,显著小于TRG组52.9%和85.3%(P<0.001)。ERAS组术后24 H、1周VAS评分(3.3±0.8)分、(2.1±0.6)分均低于TRG组(6.4±0.7)分、(3.4±0.7)分(P<0.001);ERAS组术后1周、1个月、3个月髋关节功能HARRIS评分(61.5±2.6)分、(83.7±4.2)分、(89.4±4.5)分均优于TRG组(50.2±3.8)分、(77.1±6.4)分、(83.2±3.1)分(P<0.001)。结论将ERAS理念应用于老年股骨粗隆间骨折的治疗,可减轻术后疼痛,减少输血及并发症的发生,加速关节功能恢复,对于临床工作有重要的指导意义。
OBJECTIVE To explore the application effect of Enhanced Recovery After Surgery(ERAS)concept in the treatment of intertrochanteric fractures among the elderly.METHODS A retrospective case-control study was conducted to analyze the treated 68 elderly patients with intertrochanteric fractures,all of whom underwent PFNA internal fixation for unilateral fresh fractures.The patients were randomly divided into the traditional rehabilitation group(TRG)and the Enhanced Recovery After Surgery(ERAS)group,with 34 cases in each group.The TRG received traditional mode treatment,and the ERAS group followed perioperative evidence-based medicine evidence,and strictly implemented rapid rehabilitation procedures before,during and after surgery.The differences of operation duration,intraoperative blood loss,transfusion rate,postoperative drainage volume,postoperative complications,postoperative visual analogue scale(VAS),postoperative hip function Harris score,total hospitalization time,and total treatment cost were compared between the two groups.RESULTS In the ERAS group,the total hospitalization time was(9.6±0.3)d,and the treatment cost was(3.23±0.34)ten thousand Yuan,which were lower than(15.3±2.0)d,(3.86±0.81)ten thousand Yuan in the TRG(P<0.001);In terms of intraoperative blood loss,postoperative drainage volume,and blood transfusion rate,they were(202.1±57.0)mL,(32.51±2.53)mL,11.8%in the ERAS group,which were all lower than(260.3±75.2)mL,(89.45±4.02)mL,38.2%in the TRG(P<0.001);The incidence of postoperative nausea,and vomiting,and thirst,hunger and abdominal distension in the ERAS group was 8.8%and 17.6%,respectively,significantly lower than 52.9%and 85.3%in the TRG(P<0.001).Postoperative VAS scores in the ERAS group for 24 h and 1 week were(3.3±0.8),(2.1±0.6),which were lower than(6.4±0.7),(3.4±0.7)in the TRG(P<0.001);Postoperative hip function Harris score in the ERAS group for 1week,1 month,and 3 months were(61.5±2.6),(83.7±4.2),(89.4±4.5),which were superior to(50.2±3.8),(77.1±6.4),(83.2±3.1)in the TRG(P
作者
崔海峰
段大鑫
王翰
Cui Haifeng;Duan Daxin;Wang Han
出处
《中国疗养医学》
2020年第11期4206-4208,共3页
Chinese Journal of Convalescent Medicine
关键词
快速康复外科理念
老年粗隆间骨折
应用效果
Enhanced Recovery After Surgery
Intertrochanteric fractures among the elderly
Application effect
