加速康复外科对高龄老年全膝关节置换术患者的疗效分析

王崇佳; 顾春江; 章志望; 王春; 郑春雷

doi:10.16766/j.cnki.issn.1674-4152.003893

加速康复外科对高龄老年全膝关节置换术患者的疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003893

杭州医学院桐乡市第一人民医院，浙江嘉兴 314500

基金项目:

浙江省卫生健康科技计划项目 2022KY1277

详细信息

通讯作者:
顾春江，E-mail：1550864223@qq.com

中图分类号: R687.4
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- 文章访问数: 9
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-16
- 网络出版日期: 2025-03-27

Analysis of the therapeutic effect of enhanced recovery after surgery for elderly patients with total knee arthroplasty

Tongxiang First People's Hospital of Hangzhou Medical College, Jiaxing, Zhejiang 314500, China

摘要

摘要: 目的探索老年全膝关节置换术(TKA)患者应用加速康复外科(ERAS)管理的效果和安全性。方法纳入2018年1月—2022年2月于桐乡市第一人民医院行TKA手术的70岁以上老年患者。采用随机数法分为ERAS组和传统组，并接受不同的围手术期管理方案。记录患者的人口统计学资料、手术时间、术中失血量、输血率、住院时间、术后并发症情况。记录术前、术后第3天、1个月和1年的牛津大学膝关节评分(OKS)和膝关节主动活动度(ROM)，并进行组间比较。结果本研究共纳入202例老年患者，其中ERAS组106例，传统组96例。相比于传统组，ERAS组的术中失血量显著降低[(151.2±9.3)mL vs. (133.7±10.5)mL，P < 0.001]，住院时间显著缩短[(8.8±1.3)d vs. (10.2±1.7)d，P＜0.001]，并发症率显著降低[45.8%(44/96) vs. 30.2%(32/106)，P=0.022]，术后第3天OKS评分更高[(21.6±4.5) vs. (26.8±3.6)，P < 0.05]，术后第3天[(67.8±10.5)° vs. (71.8±7.0)°，P < 0.001]和术后1月[(80.7±8.3)° vs. (85.1±7.6)°，P < 0.001]时的活动度显著更高。2组1年随访死亡率比较差异无统计学意义(P>0.05)。结论对于70岁以上高龄老年TKA患者，ERAS可改善术后疼痛，加速术后关节功能恢复，且不增加死亡率。
- 全膝关节置换术 /
- 加速康复外科 /
- 老年 /
- 安全性
Abstract: Objective To explore the effect and safety of enhanced recovery after surgery (ERAS) management in elderly patients with total knee arthroplasty (TKA). Methods Elderly patients over 70 years old who underwent TKA surgery in Tongxiang First People's Hospital from January 2018 to February 2022 were included. They were randomized to ERAS and traditional groups and received different perioperative management programs. Patient demographic data, operation time, intraoperative blood loss, blood transfusion rate, length of hospital stay, and postoperative complications were recorded. The Oxford University knee score (OKS) and knee active range of motion (ROM) were recorded before the surgery and on day 3, 1 month, and 1 year postoperatively. Comparisons between the two groups were performed using the t-test, chi-square test, or Fisher ' s exact probability method. Results A total of 202 elderly patients were included in this study, with 106 patients in the ERAS group and 96 patients in the traditional group. Compared with the traditional group, the intraoperative blood loss in the ERAS group was significantly lower [(151.2±9.3) mL vs. (133.7±10.5) mL, P < 0.001], and the length of hospital stay was significantly shorter [(8.8±1.3) d vs. (10.2±1.7) d, P < 0.001]. The complication rate was significantly lower [45.8% (44/96) vs. 30.2% (32/106), P=0.022], and the OKS score was higher on the 3rd day after surgery [(21.6±4.5) vs. (26.8±3.6), P < 0.05]. Activity was significantly higher on the 3rd day [(67.8±10.5)° vs. (71.8±7.0)°, P < 0.001] and 1 month [(80.7±8.3)° vs. (85.1±7.6)°, P < 0.001] after the surgery. There was no significant difference in 1-year follow-up mortality between the two groups (P>0.05). Conclusion For elderly TKA, ERAS can improve postoperative pain and accelerate postoperative recovery of joint function without increasing mortality.
- Total knee arthroplasty /
- Enhanced recovery after surgery /
- Old age /
- Safety

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表 1 接受初次单侧全膝关节置换术老年患者的基线资料

Table 1. Baseline data of elderly patients undergoing primary unilateral total knee arthroplasty

项目	ERAS组(n=106)	传统组(n=96)	统计量	P值
年龄(x±s，岁)	76.2±3.3	77.4±5.9	1.806^a	0.073
女性[例(%)]	43(40.6)	38(39.6)	0.020^b	0.887
BMI(x±s)	26.8±4.1	27.2±3.7	0.725^a	0.469
手术侧别[例(%)]			0.001^b	0.982
左侧	62(58.5)	56(58.3)
右侧	44(41.5)	40(41.7)
病史[例(%)]
糖尿病	33(31.1)	24(25.0)	0.935^b	0.334
高血压	48(45.3)	35(36.5)	1.621^b	0.203
脑血管疾病	2(1.9)	0	1.829^b	0.176
肺部疾病	15(14.2)	11(11.5)	0.326^b	0.568
吸烟	13(12.3)	16(16.7)	0.794^b	0.373
饮酒	7(6.6)	5(5.2)	0.176^b	0.675
注：^a为t值，^b为χ²值。

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表 2 2组老年TKA患者围手术期情况比较

Table 2. Comparison of perioperative conditions between the two groups of elderly TKA patients.

项目	ERAS组 (n=106)	传统组 (n=96)	统计值	P值
手术时间(x±s，min)	79.2±12.7	80.5±14.8	0.672^a	0.503
术中失血量(x±s，mL)	133.7±10.5	151.2±9.3	12.486^a	< 0.001
输血[例(%)]	0	0
住院时间(x±s，d)	8.8±1.3	10.2±1.7	6.610^b	< 0.001
术后并发症[例(%)]
恶心呕吐	22(20.8)	29(30.2)	2.386^b	0.122
DVT	7(6.6)	9(9.4)	0.530^b	0.466
肺栓塞	0	0
伤口延迟愈合	0	1(1.0)	1.110^b	0.292
伤口不愈合	0	0
伤口渗液	3(2.8)	5(5.2)	0.749^b	0.387
感染	0	1(1.0)	1.110^b	0.292
合计	32(30.2)	44(45.8)	2.534^b	0.022
注：^a为t值，^b为χ²值。

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表 3 2组患者膝关节功能比较(x±s，分)

Table 3. Comparison of knee joint function between the two groups(x±s, points)

组别	例数	术前	术后3 d	术后1个月	术后1年
ERAS组	106	23.5±6.8	26.8±3.6^a	37.3±4.7^ab	42.3±3.7^abc
传统组	96	23.6±4.3	21.6±4.5^a	36.0±5.5^ab	41.1±3.7^abc
t值		0.123	9.008	1.811	0.767
P值		0.902	< 0.001	0.072	0.444
注：F_组间=4.595，P_组间=0.033；F_时间=2 020.133，P_时间 < 0.001；F_交互=12.862，P_交互 < 0.001。与同组术前比较，^aP < 0.05；与同组术后3 d比较，^bP < 0.05；与同组术后1个月比较，^cP < 0.05。

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表 4 2组患者关节活动度比较(x±s，°)

Table 4. Comparison of joint motion between the two groups(x±s, °)

组别	例数	术前	术后3 d	术后1个月	术后1年
ERAS组	106	79.2±6.6	71.8±7.0^a	85.1±7.6^ab	102.5±12.1^abc
传统组	96	81.0±6.8	67.8±10.5^a	80.7±8.3^ab	102.1±9.6^abc
t值		2.226	3.213	3.933	0.258
P值		0.058	0.002	< 0.001	0.796
注：F_组间=6.963，P_组间=0.009；F_时间=360.501，P_时间 < 0.001；F_交互=1.896，P_交互=0.170。与同组术前比较，^aP < 0.05；与同组术后3 d比较，^bP < 0.05；与同组术后1个月比较，^cP < 0.05。

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