快速康复外科理念在股骨粗隆间骨折患者中应用观察

doi:10.3969/j.issn.1009-976X.2021.04.016

摘要/Abstract

摘要： 目的探讨加速康复外科（ERAS）对股骨近端抗旋髓内钉（PFNA）固定的粗隆间骨折患者的影响。方法回顾性研究纳入100例粗隆间骨折患者,分为ERAS组（50例）和对照组（50例）,记录两组的住院天数、Harris髋关节评分（HHS）、视觉模拟量表（VAS）、日常生活活动量表（ADL）。结果 ERAS 手术与较短的住院时间、较低的术后VAS评分、较早的活动和术后3个月的平均HHS评分显著改善相关,平均住院时间从6.3±2.8减少到4.9±2.6天。结论股骨粗隆间骨折患者围手术期接受ERAS处理能够减少住院时间而不增加术后并发症和再入院率。

关键词: 粗隆间骨折, 加速康复外科（ERAS）, 近端防旋髓内钉固定

Abstract: Objective To investigate the effects of enhanced recovery after surgery （ERAS） on intertrochanteric fracture patients undergoing proximal femoral nail antirotation （PFNA） fixation. Methods 100 patients were included in this retrospective study whichwas adopted betweenpatients treated in an ERAS after intramedullary fixation with those rehabilitated on a regular pathway. The patients were assigned to ERAS group （50 cases） and control group （50 cases）.Clinicaland demographic data were collected among the two pathways including length of hospital stay, Harris hip scores （HHS）, visual analog scale （VAS）, and activity of daily living scale （ADL）. Results ERAS procedure wasassociated with shorter length of hospital stay, lower postoperative VAS scores, earlier mobilization,significant improvement in the mean HHS scores at 3 months postoperatively. The mean length of hospital staydecreased from 6.3±2.8 days to 4.9±2.6 days after implementation of ERAS pathway. Conclusion This series of intertrochanteric fracture patients treated with the orthopedic ERAS procedure demonstratedthat the procedure is capable of reducing LOS and preserving hip function without compromising functional outcome. This improvement was possible without a concomitant increase in postoperative complications and readmission rates.

Key words: intertrochanteric fracture, enhanced recovery after surgery （ERAS）, proximal femoral nail antirotation

中图分类号:

R683.42

吴柏初, 吴贤驹, 罗春强. 快速康复外科理念在股骨粗隆间骨折患者中应用观察[J]. 岭南现代临床外科, 2021, 21(04): 449-452.

WU Bo-chu, WU Xian-ju, LUO Chun-qiang. Observation of the enhanced recovery after surgery in patients with femoral intertrochanteric fractures[J]. Lingnan Modern Clinics In Surgery, 2021, 21(04): 449-452.

参考文献

[1] Michelson JD, Myers A, Jinnah R, et al.Epidemiology of hip fractures among the elderly. Risk factors for fracture type[J]. Clin Orthop Relat Res, 1995, 311:129-135.
[2] Valizadeh M, Mazloomzadeh S, Golmohammadi S, Larijani B. Mortality after low trauma hip fracture: a prospective cohort study [J]. BMC Musculoskelet Disord, 2012 Aug 10;13:143.
[3] Makki D, Matar HE, Jacob N, et al.Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures[J]. Injury, 2015, 46(12):2389-2393.
[4] Chang SM, Hou ZY, Hu SJ, Du SC.Intertrochanteric Femur Fracture Treatment in Asia: What We Know and What the World Can Learn[J]. Orthop Clin North Am, 2020, 51(2):189-205.
[5] Nayak M, Yadav R, Ganesh V, Digge V.An unusual case of femoral head perforation following fixation with proximal femoral nail antirotation (PFNA-II) for an unstable intertrochanteric fracture: Case report and literature review[J]. Trauma Case Rep, 2019, 20:100178.
[6] Nherera L, Trueman P, Horner A, et al.Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures[J]. J Orthop Surg Res, 2018, 13(1):46.
[7] Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS?) Society recommendations[J]. Acta Orthop, 2020, 91(1):3-19.
[8] Debono B, Wainwright TW, Wang MY, et al.Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS?) Society recommendations[J]. Spine J, 2021, 21(5):729-752.
[9] Kang Y, Liu J, Chen H, et al.Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome[J]. J Orthop Surg Res, 2019, 14(1):209.
[10] Nishiura T, Nozawa M, Morio H.The new technique of precise insertion of lag screw in an operative treatment of trochanteric femoral fractures with a short intramedullary nail[J]. Injury. 2009, 40(10):1077-1083.
[11] Borges A, Torres J, São Simão R,et al.Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures[J]. Acta Med Port, 2014, 27(2):218-222.
[12] Lambers A, Rieger B, Kop A, et al.Implant Fracture Analysis of the TFNA Proximal Femoral Nail[J]. J Bone Joint Surg Am, 2019, 101(9):804-811.
[13] Dunn J, Kusnezov N, Bader J, et al.Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review[J]. J Orthop Traumatol, 2016, 17(4):361-367.
[14] Liu VX, Rosas E, Hwang J, et al.Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system[J]. JAMA Surg, 2017, 152(7):e171032.
[15] Liu VX, Rosas E, Hwang J, et al.Enhanced recovery after surgery programimplementation in 2 surgical populations in an integrated health caredelivery system[J]. JAMA Surg, 2017, 152(7):e171032.