加速康复外科理念指导下混合型单髁关节置换术后的疗效分析

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摘要目的探讨在加速康复外科理念(enhanced recovery after surgery，ERAS)指导下的初次混合型单髁关节置换术(unicompartmental knee arthroplasty，UKA)治疗前内侧膝骨关节炎的临床疗效分析。方法 2018年2月至2019年6月我科收治75例前内侧骨关节炎行初次混合型单髁膝关节置换术患者，采用随机数字表法分为两组，加速康复理念指导下的手术患者40例(观察组)，常规手术患者35例(对照组)。观察组男性17例，女性23例，年龄47~82岁，平均(58.63±7.95)岁；对照组男性10例，女性25例，年龄46~71岁，平均(60.80±5.76)岁。比较两组手术出血量、术后下地时间、住院时间、术后24 h血红蛋白降低值，术前和术后1 d、3 d、7 d、1个月、3个月、12个月的疼痛视觉模拟评分(visual analogue scale/score，VAS)，术前、术后1个月、3个月及12个月的膝关节美国特种外科医院(hospital for special surgery，HSS)膝关节评分和术后膝关节活动度(range of motion，ROM)。记录末次随访时感染、假体松动、假体周围骨折及下肢深静脉血栓形成等术后并发症发生情况。结果术中出血量、术后下地时间、住院时间观察组显著低于对照组，差异有统计学意义(P＜0.05)；术后24 h血红蛋白降低数值低于对照组，差异有统计学意义(P＜0.05)；术后1 d、3 d、7 d、1个月、3个月VAS疼痛评分，术后1个月、3个月膝关节HSS评分、术后膝关节ROM观察组优于对照组，差异有统计学意义(P＜0.05)；术后12个月VAS评分、膝关节HSS评分、术后膝关节ROM差异无统计学意义(P＞0.05)。结论加速康复理念指导下的混合型单髁膝关节置换术能够有效控制疼痛，减少术中出血，改善膝关节功能，可以缩短住院时间、降低并发症发生，促进患者早期、快速恢复，提高患者满意度。

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	郭东辉
	马世强
	赵云超
	董军
	周婷婷
	贾改改
	邢宝瑞
	李晓明 *

关键词 ：单髁膝关节置换术, 前内侧膝骨关节炎, 加速康复, 混合型单髁

Abstract：Objective To explore the clinical outcomes of the primary mixed unicompartmental knee arthroplasty(UKA) under the guidance of enhanced recovery after surgery(ERAS) in the treatment of anteromedial knee osteoarthritis.Methods From February 2018 to June 2019，a total of 75 patients who underwentprimary mixed unicompartmental knee arthroplasty for anteromedial osteoarthritis in our hospital were enrolled in this study underwent and randomly divided into two groups，which included 40 cases of surgical patients guided by the concept of enhanced rehabilitation(observation group) and 35 cases of routine surgery patients(control group).There were 17 males and 23 females in the observation group，aged 47~82 years old，with an average of (58.63±7.95)years；in the control group，10 males and 25 females，aged 46~71 years old，with an average of (60.80±5.76)years old.The surgical blood loss，postoperative time in the field，hospitalization time，24 h postoperative hemoglobin reduction，postoperative pain score Visual Analogue Scale/Score(VAS)，Hospital for Special Surgery(HSS) knee score，knee Joint Range of Motion(ROM) after surgery were compared.The postoperative complications such as infection，prosthesis loosening，fractures around the prosthesis，and deep vein thrombosis of the lower extremities were recorded at the last follow-up.Results Intraoperative blood loss，postoperative time in the field，and hospital stay in observation group was significantly lower than that of the control group(P＜0.05).The value of hemoglobin reduction at 24 hours after surgery in observation group was significantly lower than that of the control group(P＜0.05).VAS pain score at 1 day，3 days，7 days，1 month and 3 months after surgery，HSS score at 1 month and 3 months after surgery，and the ROM in observation group were better than the control group(P＜0.05).The VAS score，knee HSS score，and postoperative ROM at 12 months after operation had no significance difference (P＞0.05).Conclusion The primary mixed unicompartmental knee arthroplasty guided by the concept of ERAS can effectively control pain，reduce intraoperative bleeding，improve knee joint function，shorten hospital stay，reduce complications，and promote early recovery of patients，improve satisfaction and promote rapid recovery of patients.

Key words： unicompartmental knee arthroplasty anteromedial knee osteoarthritis accelerated rehabilitation mixed unicompartmental knee arthroplasty

基金资助:河北省卫计委项目(20180969)

通讯作者: 李晓明

作者简介: 郭东辉(1981－ )，男，副主任医师，河北省沧州中西医结合医院骨关节外三科，061000。

引用本文:

郭东辉，马世强，赵云超，董军，周婷婷，贾改改，邢宝瑞，李晓明 *. 加速康复外科理念指导下混合型单髁关节置换术后的疗效分析[J]. 实用骨科杂志, 2021, 27(10): 913-917.

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