摘要
目的分析加速康复外科(enhanced recovery after surgery,ERAS)在老年髋关节置换术(hip arthroplasty,HA)患者中的应用效果。方法选取我院2022年1月至2024年6月收治的130例老年髋部骨折患者,采用随机数字表法将患者分为对照组(n=65)和ERAS组(n=65)。比较两组患者围术期指标(手术时间、术中失血量、离床时间、住院时间、术后并发症),采用数字评分量表(numerical rating scale,NRS)评估疼痛程度,采用Kendall肌力分级、起立-行走计时测试(timed up and go test,TUGT)、步态分析评估肌肉力量和步态状况,采用Harris髋关节评分(Harris hip score,HHS)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)、日常生活能力量表(activities of daily living scale,ADL)评估髋部功能和活动能力。结果ERAS组手术时间、离床时间和住院时间均短于对照组(P<0.05)。术后第1天、第2天、第3天、第4天和第5天ERAS组静息状态和活动状态的NRS评分均低于对照组(P<0.05)。术后1个月和3个月时,ERAS组TUGT评分低于对照组,肌肉功能强于对照组(P<0.05);术后3个月时,ERAS组跨步长、速度、摆动速度、步长和平均速度均大于对照组(P<0.05)。术后1个月、3个月和6个月时,ERAS组HHS和ADL评分高于对照组,WOMAC评分低于对照组(P<0.05)。术后1年时,ERAS组术后总并发症发生率低于对照组(7.7%vs.21.5%,P=0.025)。结论ERAS方案能有效优化老年HA患者围术期指标,提高治疗效果,缩短离床时间和住院时间,降低并发症发生率和术后疼痛程度,早期改善髋关节功能,提高生活质量。
Objective To analyze the application effect of enhanced recovery after surgery(ERAS)in elderly hip arthroplasty(HA)patients.Methods A total of 130 cases of elderly hip fracture admitted to our hospital from January 2022 to June 2024 were selected,and the patients were divided into the control group(n=65)and the ERAS group(n=65)using the randomized numerical table method.The perioperative indicators(operation time,intraoperative blood loss,off-bed time,hospitalization time,postoperative complications)between the two groups were compared.Pain level was assessed using the numerical rating scale(NRS).Kendall's muscle strength classification,timed up and go test(TUGT),gait analysis were performed to assess muscle strength and gait status;The Harris Hip Score(HHS),Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Activities of Daily Living scale(ADL)to assess hip function and mobility.Results Surgical time,off-bed time and hospitalization time were shorter in the ERAS group than in the control group(P<0.05).The NRS scores of resting and active states were lower in the ERAS group than in the control group on postoperative days 1,2,3,4 and 5(P<0.05).At 1 and 3 months postoperatively,the TUGT score was lower and muscle function was stronger in the ERAS group than in the control group(P<0.05);at 3 months postoperatively,stride length,speed,swing speed,step length,and average speed were greater in the ERAS group than in the control group(P<0.05).At 1,3 and 6 months postoperatively,HHS and ADL scores were higher and WOMAC scores were lower in the ERAS group than in the control group(P<0.05).At 1 year postoperatively,the total postoperative complication rate was lower in the ERAS group than in the control group(7.7%vs.21.5%,P=0.025).Conclusions The ERAS protocol can effectively optimize the perioperative indexes of elderly HA patients,improve the therapeutic effect,shorten the off-bed time and hospital stay,reduce the complication rate and the degree of postoperative pain,and improve the hip function at an early stage and the quality of life.
作者
严焱兰
晏婷婷
汪婷玉
YAN Yan-lan;YAN Ting-ting;WANG Ting-yu(Department of Orthopaedics,the Second People's Hospital of Hefei City,Heifei,Anhui,230011,China)
出处
《中国骨与关节杂志》
2025年第9期816-821,共6页
Chinese Journal of Bone and Joint
关键词
术后加速康复
老年人
髋骨折
关节成形术
置换
髋
Enhanced recovery after surgery
Aged
Hip fractures
Arthroplasty,replacement,hip
