[1]钟俊青,王连成.快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究[J].中华老年骨科与康复电子杂志,2016,(02):87-91.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
 Zhong Junqing,Wang Liancheng..Prospective study of the effect of fast track surery on peri-operative rehabilitation of elderly intertrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):87-91.[doi:10.3877/cma.j.issn.2096-0263.2016.02.005]
点击复制

快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究()
分享到:

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2016年02期
页码:
87-91
栏目:
髋部骨折
出版日期:
2016-05-17

文章信息/Info

Title:
Prospective study of the effect of fast track surery on peri-operative rehabilitation of elderly intertrochanteric fracture
作者:
钟俊青王连成
300211 天津市天津医院康复科
Author(s):
Zhong Junqing Wang Liancheng.
Department of Rehabilitation Medicine, Tianjin Hospital, Tianjin 300210, China
关键词:
髋骨折 老年人 康复 快速外科通道
Keywords:
Hip Fractures Aged Rehabilitation Fast track surgery
DOI:
10.3877/cma.j.issn.2096-0263.2016.02.005
摘要:
目的 比较快速外科通道(fast track surgery,FTS)理念和非FTS 理念指导下进行老年股骨转子间骨折围手术期康复的治疗效果。方法 前瞻性收集天津骨科医院2013 年6 月至2014 年 3 月确诊为老年股骨转子间骨折且符合纳入及排除标准的患者32 例,随机分为FTS 组(n=16)和非FTS 组(n=16),FTS 组患者采用FTS 理念指导下的康复程序,非FTS 组采用围手术期常规康复程序,随访并比较两组患者术后的Harris 评分、患者满意度、疼痛视觉模拟评分(visual analogue score,VAS)及住院天数,观察并发症的发生情况。结果 32 例患者均获得随访,随访时间9 ~ 17 个月,平均(12.0±2.4)个月。术前两组VAS 评分比较差异无统计学意义(P > 0.05),术后2 周FTS 组明显低于非FTS 组,差异有统计学意义(t=1.390,P < 0.05)。术前两组Harris 评分比较差异无统计学意义(P > 0.05),术后8 周FTS 组明显高于非FTS 组,差异有统计学意义(t=0.244, P < 0.05)。FTS 组患者的住院时间少于非FTS 组,差异具有统计学意义(t=0.833,P < 0.05)。 FTS 组患者的满意度评分高于非FTS 组,差异具有统计学意义(t=2.855,P < 0.05)。非FTS 组有 2 例术后发生下肢深静脉血栓,1 例发生浅表组织感染,两组患者各有1 例患者术后出现肾衰竭,经治疗好转。结论 老年股骨转子间骨折采用FTS 理念可以加速患者的康复,减轻患者疼痛,提高患者满意度及康复治疗效果。
Abstract:
Objective To compare the efficacy of peri-operative rehabilitation between the fast track surgery (FTS) and non-FTS with elderly intertrochanteric fractures. Methods 32 patients with elderly intertrochanteric fractures in the Tianjin orthopaedic hospital during June 2013 to March 2014 were collected. All patients were divided into FTS group (n=16) and non-FTS group (n=16) randomly, FTS group was treated with FTS and the non-FTS group was under routine perioperative rehabilitation program. Comparison were performed between two groups on postoperative by Harris score, patient satisfaction, visual analogue score (VAS), length of stay (LOS) and postoperative complication. Results 32 patients were followed-up for 9-17 months, with an average of (12.0±2.4) months. There was no statistically significant difference in preoperative VAS score between the two groups (P>0.05). And 2 weeks after surgery, VAS of FTS group was obviously lower than the non-FTS group, the difference was statistically significant (t=1.390, P<0.05). There was no statistically significant difference in preoperative Harris score between the two groups (P>0.05), while difference of Harris score between two groups were significant after 8 weeks (t=0.244, P<0.05). Length of stay of FTS group was less than that of the non-FTS group, there was statistically significant difference (t=0.833, P<0.05). Satisfaction scores of FTS group were higher than non-FTS group, the difference was statistically significant (t=2.855, P<0.05). In FTS group, 2 cases had postoperative deep vein thrombosis of lower limb, 1 case had superficial tissue infection, both groups had 1 case of postoperative renal failure, and got relieved after treatment. Conclusion FTS can effectively promote the rehabilitation process, reduce the pain and improve patient satisfaction in elderly intertrochanteric fractures.

参考文献/References:

1 Wilmore D W . From Cathbertson to Fast—Track Sugery : 70 years of progression in reducing stress in surgical patients.A nn Surg, 2002 , 236 : 643 -648.
2 Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg, 2002, 183(6): 630-641.
3 宋世锋, 姚伦龙, 张熙民, 等. 高龄患者髋部骨折的治疗(附149例分析) [J]. 中国矫形外科杂志, 2002, 9(7): 633-635.
4 王晓伟, 孙天胜, 刘智, 等. 老年髋部骨折手术疗效的危险因素分析 [J]. 中华创伤骨科杂志, 2011, 13(9): 811-816.
5 HCAHPS MaiL Survey Materials[EB/OL]. http://www.heahps.org/home.aspx/ 2015-6-14/ 2015-7-12
6 马江涛, 俞敏, 俞高峰, 等. 快速康复外科理论在老年股骨转子间骨折治疗中的应用 [J]. 中医正骨, 2015, 27(1): 39-40.
7 Osaki M. Hip fracture-epidemiology, management and liaison service. Rehabilitation for the hip fracture [J]. Clin Calcium, 2015, 25(4): 577-584.
8 Michaelsson K, Nordstrom P, Nordstrom A, et al. Impact of hip fracture on mortality: a cohort study in hip fracture discordant identical twins [J]. J Bone Mine Res, 2014, 29(2): 424-431.
9 姜洪池, 孙备, 王刚. 快速康复外科的新理念值得重视 [J]. 中华外科杂志, 2007, 45(9): 577-579.
10 付丽敏, 杨小华, 吕永明, 等. 加速康复外科在全膝置换患者康复治疗中的应用 [J]. 中国组织工程研究与临床康复, 2011, 15(22): 4019-4022.
11 严伟. 老年骨科手术患者下肢深静脉血栓的预防与治疗 [J]. 中国老年学杂志, 2011, 31(9): 1660-1661.
12 周谋望. 加强骨科康复 [J]. 中国康复理论与实践, 2003, 9(12): 756-757.

相似文献/References:

[1]吴斗,郝海虎,朱剑,等.老年髋部骨折术后谵妄的危险因素分析[J].中华老年骨科与康复电子杂志,2015,(01):34.
[2]姬晨妮,陈伟,朱燕宾,等.京津唐地区1 583例老年股骨转子间骨折流行病学特征分析[J].中华老年骨科与康复电子杂志,2015,(01):45.
[3]沈鹏程 朱立帆 蒋富贵 鞠文 徐能 李晓林.锁定钢板结合重建肱骨内侧柱治疗老年不稳定型肱骨近端骨折的疗效分析[J].中华老年骨科与康复电子杂志,2015,(02):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
 Shen Pengcheng,Zhu Lifan,Jiang Fugui,et al.Clinical research of locking plate combined with medial column mechanical support for unstable fractures of the proximal humerus in elderly patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(02):7.[doi:10.3877/cma.j.issn.2096-0263.2015.02.002]
[4]刘文宣 张宇宸 刘文聪 高霞 李涛 张晓琳.CTR 基因多态性与老年男性骨质疏松的相关性研究[J].中华老年骨科与康复电子杂志,2015,(02):19.[doi:10.3877/cma.j.issn.2096-0263.2015.02.004]
 Liu Wenxuan,Zhang Yuchen,Liu Wencong,et al.Association between calcitonin receptor gene polymorphism and osteoporosis in elderly men[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(02):19.[doi:10.3877/cma.j.issn.2096-0263.2015.02.004]
[5]董仁卫 郭琪 王家仲 王连成.老年人群肌力水平与心血管疾病 三大危险因素的相关性研究[J].中华老年骨科与康复电子杂志,2015,(02):29.[doi:10.3877/cma.j.issn.2096-0263.2015.02.006]
 Dong Renwei,Guo Qi,Wang Jiazhong,et al.The association between muscle strength level and three major risk factors of cardiovascular disease in elderly population[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(02):29.[doi:10.3877/cma.j.issn.2096-0263.2015.02.006]
[6]李森磊,孙立,杨先腾,等.老年髋关节置换术后认知功能障碍的危险因素分析[J].中华老年骨科与康复电子杂志,2016,(02):71.[doi:10.3877/cma.j.issn.2096-0263.2016.02.002]
 Li Senlei,Sun Li,Yang Xianteng,et al.Risk factors analysis for postoperative cognitive dysfunction in  elderly patients undergoing hip arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):71.[doi:10.3877/cma.j.issn.2096-0263.2016.02.002]
[7]裴宝瑞,吴啸波,李力更,等.应用低分子肝素钙预防老年髋部骨折术前静脉血栓栓塞症的剂量研究[J].中华老年骨科与康复电子杂志,2016,(02):76.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
 Pei Baorui,Wu Xiaobo,Li Ligeng,et al.The efficacy of low molecular weight heparin calcium of preventive versus therapeutic dose in prevention of venous thromboembolism in elderly patients before hip fracture surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):76.[doi:10.3877/cma.j.issn.2096-0263.2016.02.003]
[8]赵德伟,马志杰,杨磊,等.多孔钽金属涂层髋关节假体置换治疗老年股骨颈骨折的临床疗效观察[J].中华老年骨科与康复电子杂志,2016,(02):92.[doi:10.3877/cma.j.issn.2096-0263.2016.02.006]
 Zhao Dewei,Ma Zhijie,Yang Lei,et al.Clinical investigation of hip implants by using porous tantalum coating in the treatment of elderly femoral neck fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):92.[doi:10.3877/cma.j.issn.2096-0263.2016.02.006]
[9]宋会平,张柳.阿仑膦酸钠治疗老年女性严重骨质疏松症患者的疗效分析[J].中华老年骨科与康复电子杂志,2016,(03):141.[doi:10.3877/cma.j.issn.2096-0263.2016.03.003]
 Song Huiping,Zhang Liu.Effcacy analysis of alendronate in the treatment of severe osteoporosis in senile women[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):141.[doi:10.3877/cma.j.issn.2096-0263.2016.03.003]
[10]柴仪,田伟明,温志刚.经皮椎体后凸成形术治疗高龄骨质疏松性椎体压缩骨折的疗效分析[J].中华老年骨科与康复电子杂志,2016,(03):150.[doi:10.3877/cma.j.issn.2096-0263.2016.03.005]
 Chai Yi,Tian Weiming,Wen Zhigang.Curative effective analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fracture in senile patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):150.[doi:10.3877/cma.j.issn.2096-0263.2016.03.005]
[11]吴啸波,裴宝瑞.老年髋部骨折围手术期相关问题的研究进展[J].中华老年骨科与康复电子杂志,2016,(02):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
 Wu Xiaobo,Pei Baorui..Perioperative related problems of surgery in elderly patients with hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):114.[doi:10.3877/cma.j.issn.2096-0263.2016.02.010]
[12]侯建伟,谢仁国,李玉前,等.加长型 PFNA-Ⅱ和DHS治疗老年骨质疏松性股骨转子下骨折的疗效分析[J].中华老年骨科与康复电子杂志,2017,(01):22.[doi:10.3877/cma.j.issn.2096-0263.2017.01.005]
 Hou Jianwei,Xie Renguo,Li Yuqian,et al.Clinical effective analysis of lengthened PFNA- II fixation and dynamic hip screw for senile osteoporotic subtrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):22.[doi:10.3877/cma.j.issn.2096-0263.2017.01.005]
[13]于沂阳,李石伦,陈伟,等.中国北方和南方地区 2010—2011年 60岁以上人群股骨转子间骨折流行病学对比[J].中华老年骨科与康复电子杂志,2017,(01):55.[doi:10.3877/cma.j.issn.2096-0263.2017.01.011]
 Yu Yiyang,Li Shilun,Chen Wei,et al.Epidemiological comparison of geriatric intertrochanteric fractures between north and south areas of China from 2010 to 2011[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):55.[doi:10.3877/cma.j.issn.2096-0263.2017.01.011]
[14]徐进,李平,马信龙.老年髋部骨折手术快通道化变革中的麻醉管理[J].中华老年骨科与康复电子杂志,2017,(01):59.[doi:10.3877/cma.j.issn.2096-0263.2017.01.012]
 Xu Jin,Li Ping,Ma Xinlong.Anesthetic management of immediate reparative surgery in elderly patients with hip fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):59.[doi:10.3877/cma.j.issn.2096-0263.2017.01.012]
[15]刘雅克,王洪,朱鸣镝,等.老年髋部骨折术后对侧再骨折的随访研究[J].中华老年骨科与康复电子杂志,2017,(04):205.[doi:10.3877/cma.j.issn.2096-0263.2017.04.003]
 Liu Yake,Wang Hong,Zhu Mingdi,et al.The contralateral fractures after the hip fracture in the elderly[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):205.[doi:10.3877/cma.j.issn.2096-0263.2017.04.003]
[16]刘中砥,徐海林,陈建海,等.解剖型股骨近端髓内钉治疗老年转子间骨折的初步疗效[J].中华老年骨科与康复电子杂志,2017,(05):265.[doi:10.3877/cma.j.issn.2096-0263.2017.05.003]
 Liu Zhongdi,Xu Hailin,Chen Jianhai,et al.Clinical effectiveness of Zimmer Natural Nail System (ZNN) for treatment of elderly intertrochanteric fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):265.[doi:10.3877/cma.j.issn.2096-0263.2017.05.003]
[17]沈浩,王伟,何继业,等.老年髋部骨折术前合并急性脑梗塞的危险因素分析[J].中华老年骨科与康复电子杂志,2017,(05):275.[doi:10.3877/cma.j.issn.2096-0263.2017.05.005]
 Shen Hao,Wang Wei,He Jiye,et al.Risk factors analysis for preoperative acute cerebral infarction in elderly hip fracture patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):275.[doi:10.3877/cma.j.issn.2096-0263.2017.05.005]
[18]郝亚逢,李远,王治乾,等.左西孟旦治疗围手术期老年髋部骨折合并心衰患者的疗效研究[J].中华老年骨科与康复电子杂志,2018,(01):29.[doi:10.3877/cma.j.issn.2096-0263.2018.01.007]
 Hao Yafeng,Li Yuan,Wang Zhiqian,et al.Effectivness study of Leosimendan in the treatment of perioperative in elderly hip fracture with heart failure[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(02):29.[doi:10.3877/cma.j.issn.2096-0263.2018.01.007]
[19]鲁攀攀,马彬彬,李荥娟,等.老年髋部骨折患者术前营养不良的危险因素分析[J].中华老年骨科与康复电子杂志,2018,(03):145.[doi:10.3877/cma.j.issn.2096-0263.2018.03.005]
 Lu Panpan,Ma Binbin,Li Yingjuan,et al.Risk factors analysis for preoperative malnutrition of elderly hip fracture patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(02):145.[doi:10.3877/cma.j.issn.2096-0263.2018.03.005]
[20]王小波,李雪飞,白晓彬.股骨近端防旋髓内钉治疗老年股骨转子间骨折的临床疗效观察[J].中华老年骨科与康复电子杂志,2018,(03):158.[doi:10.3877/cma.j.issn.2096-0263.2018.03.007]
 Wang Xiaobo,Li Xuefei,Bai Xiaobin.Clinical observation of proximal femoral nail anti rotation intramedullary nail (PFNA) in the treatment of intertrochanteric fractures in the elderly[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(02):158.[doi:10.3877/cma.j.issn.2096-0263.2018.03.007]

备注/Memo

备注/Memo:
天津滨海新区卫生局医药卫生科技项目(2011BH-KY017)
更新日期/Last Update: 2016-05-17