加速康复方式对老年患者全膝关节置换术后的影响

目的探讨不同的康复方式对老年全膝关节置换术患者术后焦虑、镇痛效果及生活质量的影响。 方法选取2017年11月到2020年6月于海南西部中心医院骨科门诊收入院的退行性膝关节炎老年患者100例，年龄≥65岁，均为初次行单侧全膝关节置换术，排除存在既往膝关节手术史、下肢其他关节功能障碍、凝血功能异常、下肢深静脉血栓(DVT)以及依从性差的患者。所有患者由同一高年资手术医师完成手术。按随机数字法分为两组，其中实验组给予加速康复措施，对照组给予常规康复措施，记录包括手术时间、住院时间、术中出血量，评估住院指标。于术前、术后1个月、术后6个月评估患者疼痛视觉评分(VAS)、焦虑自评量表系统评分(SAS)、膝关节综合评分(AKS)及生活质量评分(SF-36)。记录患者自手术至术后6个月内发生的手术相关性感染、DVT、假体松动、关节返修、骨关节炎进展等发生情况。计量资料采用独立样本t检验，重复测量资料比较采用球形检验，若不满足球型分布，需采用Green house-Geisser方法对自由度进行校正后计算；计数资料采用卡方检验或Fisher精确检验。 结果实验组较对照组手术时间(t＝8.618)、住院时间(t＝4.116)较短，首次下床时间(t＝16.360)较早，术中出血量及住院总花费较少(t＝16.359、5.839，均为P<0.05)。经治疗，两组VAS评分、SAS评分均降低，AKS评分、SF-36评分均升高。术前、术后1个月、术后6个月两组患者SAS、VAS、AKS及SF-36评分均不满足球型分布，实验组SAS、VAS评分均低于对照组(F＝5.201、9.018)，AKS评分(F＝7.231、10.205)、SF-36评分(F＝20.102、7.118)均高于对照组，差异有统计学意义(均为P<0.05)，且无交互作用(均为P>0.05)。实验组并发症发生率为10.0%，对照组为28.0%,差异有统计学意义(χ²＝5.263，P＝0.022)。 结论加速康复外科可优化老年全膝关节置换术患者的住院指标，减少术中出血及术后并发症，缓解焦虑，提高镇痛效果、膝关节功能及生活质量。

Postoperative effects of enhanced recovery on elderly patients of total knee replacement

ObjectiveTo explore the effects of different rehabilitation methods on postoperative anxiety, analgesia and quality of life in elderly patients undergoing total knee arthroplasty. MethodsA total of 100 elderly patients with degenerative knee arthritis (≥65 years old) who received unilateral total knee replacement for the first time were selected from November 2017 to June 2020 in the Department of Orthopedics Outpatient Department of Hainan West Central Hospital. Patients with previous knee surgery, other joint dysfunction of lower extremities, abnormal coagulation function, deep vein thrombosis (DVT) of lower extremities, and poor compliance were excluded. All the patients were operated by the same senior surgeon. According to the random number method, they were divided into two groups. After the surgery, the experimental group accepted enhanced recovery, and the control group accepted conventional recovery. The records included operation time, hospitalization time, intraoperative blood loss, and evaluation of hospitalization indicators. The patients were assessed by the visual pain score (VAS), the anxiety self-rating scale system score (SAS), the knee joint comprehensive score (AKS) and the quality of life score (SF-36) before surgery, one month and six months after the surgery. The occurrence of surgery-related infections, DVT, prosthesis loosening, joint repair, and progression of osteoarthritis that occurred within six months after the surgery were recorded. The independent-sample t test was used for measurement data, spherical test was used for comparison of repeated measurement data. When the spherical distribution was not satisfied, the degree of freedom needed to be corrected by the Green house-Geisser method . The count data were calculated by chi-square test or Fisher′s exact test. ResultsCompared with the control group, the experimental group had shorter operation time (t=8.618), shorter hospitalization time (t=4.116), earlier time to get out of bed (t=16.360), less intraoperative blood loss and total hospitalization cost (t=16.359, 5.839, both P < 0.05). After treatment, VAS score and SAS score decreased, AKS score and SF-36 score increased in both groups. SAS, VAS, AKS and SF-36 scores in the two groups did not meet the spherical distribution before surgery, one month after surgery and six months after surgery. SAS and VAS scores in the experimental group were lower than those in the control group (F=5.201, 9.018). AKS score (F=7.231, 10.205) and SF-36 score (F=20.102, 7.118) were higher than those of the control group, the differences were statistically significant (all P <0.05), and there was no interaction (all P > 0.05). The incidence of complications was 10.0% in the experimental group and 28.0% in the control group, the difference was statistically significant (χ²=5.263, P=0.022). ConclusionEnhanced recovery after surgery can optimize the hospitalization indicators of elderly patients undergoing total knee arthroplasty, reduce intraoperative bleeding and postoperative complications, relieve anxiety, improve analgesic effect, knee joint function and quality of life.