[1]邱晓,黄钢勇,吴建国,等.ERAS结合SuperPATH入路人工股骨头置换术治疗老年股骨颈骨折[J].中华老年骨科与康复电子杂志,2021,(05):264-270.[doi:DOI：10.3877/cma.j.issn.2096-0263.2021.05.003]
　Qiu Xiao,Huang Gangyong,Wu Jianguo,et al.ERAS combined with SuperPATH artificial femoral head replacement for the treatment of elderly femoral neck fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2021,(05):264-270.[doi:DOI：10.3877/cma.j.issn.2096-0263.2021.05.003]
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ERAS结合SuperPATH入路人工股骨头置换术治疗老年股骨颈骨折()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2021年05期
页码:
264-270
栏目:
髋部骨折
出版日期:
2021-11-05

文章信息/Info

Title:
ERAS combined with SuperPATH artificial femoral head replacement for the treatment of elderly femoral neck fractures
作者:
邱晓1; 黄钢勇2; 3; 吴建国2; 3; 余昭衡4; 夏军3; 王思群3; 魏亦兵3; 陈飞雁3; 陈杰3; 石晶晟3; 赵广雷3
201907 上海，复旦大学附属华山医院北院康复科1，骨科2；200040 上海，复旦大学附属华山医院骨科3；201907 上海，复旦大学附属华山医院北院麻醉科4
Author(s):
Qiu Xiao1;  Huang Gangyong2; 3;  Wu Jianguo2; 3;  Yu Zhaoheng4;  Xia Jun3;  Wang Siqun3;  Wei Yibing3;  Chen Feiyan3;  Chen Jie3;  Shi Jingsheng3;  Zhao Guanglei3
1Department of Rehabilitation, , 2Department of Orthopedic, Huashan Hospital North, Fudan University, Shanghai 201907; 3Department of Orthopedic, Huashan Hospital, Fudan University, Shanghai 200040; 4Department of Anesthesiology, Huashan Hospital North, Fudan University, Shanghai 201907, China
关键词:
加速康复外科理念;  关节成形术; 置换; 髋;  股骨颈骨折
Keywords:
Enhanced recovery after surgery;  Arthroplasty;  Femoral neck fractures
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2021.05.003
文献标志码:
A
摘要:
目的 探讨加速康复外科（ERAS）理念下SuperPATH入路人工股骨头置换术治疗高龄老年股骨颈骨折的临床特点，分析该模式的临床获益和医疗风险。方法 前瞻性收集SuperPATH入路人工股骨头置换术治疗老年股骨颈骨折患者80例，其中ERAS组和常规康复组各40例，比较两组患者性别、年龄、术前评分、合并症、血红蛋白水平、失血量、输血率、并发症率、住院时间、髋关节Harris 评分、独立行走能力、EQ-5D评分。结果 80例患者均获得完整随访，随访率100%，随访时间3～36个月，平均（15±7）个月。其中ERAS组随访时间3～31个月，平均（14±7）个月；常规康复组随访时间3～34个月，平均（16±7）个月。ERAS组和常规康复组患者年龄分别为（81±5）岁和（81±4）岁，两组患者有内科合并症者分别为95%和97.5%。两组在性别、年龄、合并症、ASA分级、术前行走能力和认知状态等指标差异无统计学意义（P＞0.05）。ERAS组术中出血量、总出血量、异体输血率和术后并发症和住院时间均较常规康复组明显减少（P＜0.05）。ERAS组和常规康复组术后并发症的发生率分别为25.0%和47.5%，两组住院时间均大于10 d。两组术后12个月Harris评分、独立行走能力和2年总体生存率（Kaplan-Meier曲线）差异无统计学意义（P＞0.05）。结论 ERAS理念下SuperPATH人工股骨头置换术可加速康复，但围手术期并发症率仍然较高，住院时间较长。合并症较多的老年股骨颈骨折行ERAS需强调以病人为中心，着重个体化处置ERAS各个环节，增“速”保“质”。
Abstract:
Objective To explore the clinical characteristics of artificial femoral head replacement with SuperPATH approach under the enhanced recovery after surgery (ERAS) concept for the treatment of femoral neck fractures in the elderly, and analyze the clinical benefits and medical risks of this model. Methods A prospective data collection of 80 elderly patients with femoral neck fractures treated with artificial femoral head replacement via SuperPATH approach, including 40 cases of ERAS and 40 conventional rehabilitation cases were collected, and the gender, age, preoperative score, comorbidities, hemoglobin level, blood loss, blood transfusion rate, complication rate, length of hospital stay, Harris score, independent walking ability and EQ-5D score of the two groups were compared. Results All the 80 patients were followed up completely, and the follow-up rate was 100%. The follow-up time ranged from 3 to 36 months, with an average of (15±7) months. The follow-up time of ERAS group ranged from 3 to 31 months, with an average of (14±7) months. The follow-up time of the conventional rehabilitation group was from 3 to 34 months, with an average of (16±7) months. The ages of the patients in the ERAS group and the conventional rehabilitation group were 81±5 years and 81±4 years, respectively. The patients in the two groups with medical complications were 95% and 97.5%, respectively. There were no significant differences between the two groups in indicators such as gender, age, comorbidities, ASA classification, preoperative walking ability and cognitive status (P>0.05). The intraoperative blood loss, total blood loss, allogeneic blood transfusion rate, postoperative complications and hospital stay in the ERAS group were significantly reduced compared with the conventional group (P<0.05). The incidence of postoperative complications in the ERAS group and the conventional rehabilitation group were 25.0% and 47.5, respectively, and the hospital stay in both groups was more than 10 days. There was no significant difference in Harris score, independent walking ability and 2-year overall survival rate (Kaplan-Meier curve) between the two groups at 12 months after surgery (P>0.05). Conclusion Under the ERAS concept, SuperPATH artificial femoral head replacement can speed up recovery, but the perioperative complication rate is still high, and the hospital stay is longer. The treatment of elderly femoral neck fractures with more comorbidities needs to emphasize the patient-centered approach and focus on individualized treatment of all aspects of ERAS, so as to increase the speed and to ensure the quality.

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备注/Memo

备注/Memo:
基金项目：上海市宝山区科技创新专项资金（18-E-24）
更新日期/Last Update: 2021-12-02