【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"。更多还原

【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-5 D 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, Super PATH 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.更多还原