快速康复理念在髋关节置换围手术期中的应用

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摘要目的探讨快速康复外科理念在因股骨颈骨折而行全髋关节置换术患者围手术期的应用。方法前瞻性随机对照研究分析2014年3月至2015年8月我科因股骨颈骨折而行全髋关节置换术的患者资料。将应用快速康复外科理念治疗的39例患者作为实验组，其中男10例，女29例，平均年龄(74.2±9.2)岁；应用传统康复理念治疗的40例患者作为对照组，其中男12例，女28例，平均年龄(73.9±8.7)岁。比较两组患者术后卧床时间、活动量和饮食摄入情况、并发症、疼痛、髋关节功能评分。结果所有患者随访6个月，传统康复组平均卧床时间(3.5±1.0)d，快速康复组为(2.1±0.6)d(P＜0.001)。传统康复组下地活动时间为(25.5±14.4)h，快速康复组为(37.4±10.4)h(P＜0.001)。快速康复组5例患者出现术后并发症，传统康复组为10例(P＜0.001)。术后疼痛比较差异无统计学意义。快速康复组出院当天、术后3个月、术后6个月髋关节功能评分均明显高于传统康复组(P＜0.001)。结论在因股骨颈骨折行全髋关节置换术的患者中应用快速康复外科理念安全可行，可以有效降低并发症的发生，提高患者的术后活动量，促进髋关节功能恢复，缩短平均卧床时间。

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关键词 ：全髋关节置换术, 快速康复外科理念, 股骨颈骨折

Abstract：Objective To investigate the application of the fast-track surgery in the patients with total hip arthroplasty because of fractured neck of femur.Methods Seventy-nine patients undergoing primary THR were recruited prospectively.After randomization，one group with thirty-nine patients undergoing the fast-track surgery were taken as the experimental group and forty patients undergoing the traditional treatment as the control group.We compared the length in bed，complications，pain，physical activities of daily living and postoperative function.Results All patients were followed up for 6 months.The length of bed of traditional recoery group was about (3.5±1.0)days，and the length of bed of fast-track recoery group was about (2.1±0.6)days(P＜0.001).The time of activities was about (25.5±14.4)h，and the fasttrack group was about (37.4±10.4)h (P＜0.001).Postoperative complications occurred in 5 patients in the fast-track group，while 10 cases in the traditional group(P＜0.001).The difference on the pain was not significant.The results showed that the scores of Harris were significantly higher in the fast-track recovery group than the traditional group on the day of discharge，3 months after operation and at the end of the 6 month after operation(P＜0.001).Conclusion Compared with conventional care，fast-track surgery in patients undergoing total hip arthroplasty is safe and feasible.The application of FTS contributed to significant reduction of length in bed and complications.There is significant difference regarding mobilization，postoperative function besides pain.

Key words： total hip arthroplasty fast-tract surgery neck of femur fracture

通讯作者: 刘欣伟

作者简介: 王宇(1983－ )，男，主治医师，沈阳军区总医院骨科，全军重症战创伤救治中心，110016

引用本文:

王宇 1，张攀 2，韩文锋 1，张敬东 1，宛一鸣 3，刘欣伟 1. 快速康复理念在髋关节置换围手术期中的应用[J]. 实用骨科杂志, 2017, 23(2): 110-113.
Wang Yu 1，Zhang Pan 2，Han Wenfeng 1，et al. Efficacy of Fast-tract Surgery in Fractured Neck of Femur Patients Undergoing Hip Replacement. sygkzz, 2017, 23(2): 110-113.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I2/110

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