| 王海峰,陈肖松,程迅生.加速康复外科在股骨近端防旋髓内钉治疗老年股骨转子间骨折中的应用[J].安徽医药,2020,24(3):515-519. |
| 加速康复外科在股骨近端防旋髓内钉治疗老年股骨转子间骨折中的应用 |
| Application of enhanced recovery after surgery in the treatment of intertrochanteric fractures in the elderly patients with proximal femoral nail anti?rotation |
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| DOI：10.3969/j.issn.1009?6469.2020.03.024 |
| 中文关键词: 髋骨折 围手术期医护 骨折固定术，内 老年人 快速康复外科 |
| 英文关键词: Hip fractures Perioperative care Fracture fixation,internal Aged Enhanced recovery after surgery |
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| 中文摘要: |
| 目的探讨加速康复外科( ERAS)在股骨近端防旋髓内钉( PFNA)治疗老年股骨转子间骨折的应用价值。方法选取中国人民解放军联勤保障部队第九〇一医院 2017年 1月到 2018年 6月治疗的老年股骨转子间骨折 54例，均为单侧新鲜骨折，并行 PFNA内固定术。将病人按随机数字表法分为加速康复组( ERAS组)和传统康复组( TRG组)，各 27例。 TRG组进行常规治疗， ERAS组在常规治疗外加入多种优化的 ERAS措施。比较两组手术时长、术中失血量、总住院时间、总治疗费用、术后并发症发生率、术后疼痛视觉模拟评分( VAS)及术后髋关节功能 Harris评分。结果 54例病人均获完整随访，时间范围为 6～18个月，平均 12.8个月。 ERAS组在总住院时［(8.9±0.3)d］、总治疗费用［(3.43±0.35)万元］均低于 TRG组［(14.4±3.0)d、(3.99±0.83)万元］(P＜0.01)。 ERAS组术后 24 h、1周 VAS评分［(3.4±0.8)分、(2.0±0.6)分］低于 TRG组［(6.6±0.8)分、(3.3±0.7)分］(P＜0.01)。 ERAS组术后 1周、 1月、 3月髋关节功能 Harris评分［( 53.5±2.7)分、(82.8±4.3)分、(88.4±4.6)分］均优于 TRG组［(45.2±3.8)分、(75.0±6.5)分、(82.2±3.3)分］(P＜0.01)。 ERAS组并发症发生率为 14.8%(4/27)TRG组为 55.6%(15/27)(P＜ 0.05)。手术时长、术中失血量、术后 1月 VAS评分 ERAS组与 TRG组差异无统计学意义( P＞0.05)。结论 ERAS理念在 PFNA治疗老年股骨转子间骨折中应用，可有效减轻经济负担，缩短住院时间，减少并发症的发生，促进功能恢复，对于临床工作有较高的价值。 |
| 英文摘要: |
| Objective To explore the application of enhanced recovery after surgery in the treatment of intertrochanteric fracturesin the elderly patients with the proximal femoral nail anti?rotation.Methods Fifty?four elderly patients with intertrochanteric frac? tures admitted by The 901st Hospital of Logistical Army of PLA，from January 2017 to June 2018 were analyzed retrospectively.Allpatients were unilateral fresh femoral intertrochanteric fractures and received the proximal femoral nail anti?rotation(PFNA).These patients were divided into the enhanced recovery after surgery group(ERAS group)and the traditional rehabilitation group(TRG group)according to random number table method，27 cases in each group.The TRG group received traditional treatment，while the ERAS group additionally received the concept of ERAS.The operation time，intraoperative blood loss，hospital stay，total cost of hos? pitalization，postoperative complication incidence，postoperative VAS score and postoperative hip function Harris score of the two groups were records.Results All patients were followed up for 6 to 18 months，with an average of 12.8 months.The hospital stay(8.9±0.3)days，total cost of hospitalization(3.43±0.35)ten thousand yuan of the ERAS group which were lower than the TRG group［( 14.4±3.0)d，(3.99±0.83)ten thousand yuan，P＜0.01］.The postoperative VAS score at 24 hours and at one week of the ERAS group were［( 3.4±0.8)points，(2.0±0.6)points］which were significantly lower than those in the TRG group［( 6.6±0.8) points and(3.3±0.7)points，P＜0.01］.The postoperative hip function Harris score was(53.5±2.7)points，(82.8±4.3)points and(88.4±4.6)points at one week，one month，three months，respectively，which were significantly higher than those in the TRG group for(45.2±3.8)points，(75.0±6.5)points and(82.2±3.3)points(P＜0.01).The incidence of complications was 14.8％( 4/27)in the ERAS group，and was 55.6％( 15/27)in the TRG group(P＜0.05).The ERAS group and TRG group showed no statistically signifi? cant difference in operation time，intraoperative blood loss，and postoperative VAS score at one month.Conclusion The applicationof enhanced recovery after surgery in the treatment of intertrochanteric fractures in the elderly patients with proximal femoral nail anti?rotation，can effectively reduce the patients’economic burden，shorten the length of hospital stay，reduce the incidence of post? operative complications，promote the rehabilitation of the hip function and improve patient satisfaction，which has high clinical ap? plication value. |
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