Objective: To explore the clinical effect of enhanced recovery after surgery (ERAS) for the elderly patients with femoral neck fracture. Methods: A total of 92 elderly patients with femoral neck fracture who received hemiarthroplasty from July 2018 to December 2018 in Beijing Jishuitan Hospital were enrolled in this study. The average age of the participants was (75±6) years, including 31 males and 61 females, and 72(78.3%) of the patients complicated with comorbidity. According to the perioperative management method, the patients were divided into the observational group (47 cases with ERAS) and the control group (45 cases with normal management). The data related to operation, hospitalization, complication and nursing satisfaction were compared between the 2 groups. The visual analogue scale (VAS) was used for pain evaluation. The Harris scores for hip joint and EQ-5D index scores were applied to evaluate the clinical outcomes. The follow-up were performed periodically for 3 months. The measurement data in accordance with normal distribution and homogeneity of variance were compared with t test. Results: All the surgeries completed successfully and no patient died during perioperative period. Compared with the control group, the operation rate in 48 hours (χ(2)=17.781, P<0.01), bed days (Z=-4.987, P<0.01), and medical costs (Z=-4.315, P<0.01) favored that in the observational group. The incidence of complication and nursing satisfaction showed no significant difference between the two groups (31.1% vs 14.9%, 86.7% vs 95.7%, χ(2)=3.432, 1.380, both P>0.05). The perioperative VAS score was lower in the observational group. The Harris scores were higher in the observational group after 1 months (t=4.458, P<0.01), however the quality of life for 2 groups was similar at all time points (t=1.293, 1.227, both P>0.05). Conclusion: ERAS can improve hip function and reduce the hospital stays and medical costs for patients underwent HA operation.
目的： 探讨加速康复外科（ERAS）在老年股骨颈骨折人工股骨头置换患者围手术期中的治疗效果。 方法： 将2018年7至12月在北京积水潭医院接受手术治疗的92例老年股骨颈骨折患者纳入研究，所有患者均接受人工股骨头置换术。患者男31例，女61例，年龄（75±6）岁。根据治疗方案将患者分为两组，其中观察组47例，围手术期应用ERAS模式进行管理；对照组45例，采用常规治疗和护理措施。比较两组患者手术、住院、并发症、护理满意度等指标。围手术期采用疼痛视觉模拟评分（VAS）对患者髋关节疼痛程度进行评定。术后1和3个月分别采用Harris髋关节功能评分表和欧洲五维健康量表（EQ-5D）评估患者髋部功能和生活质量。两组符合正态分布且方差齐的数据资料比较采用t检验。 结果： 所有患者均顺利完成手术，围手术期无患者死亡。与对照组相比，观察组患者48 h内手术率高（χ(2)=17.781，P<0.01）、住院时间短（Z=-4.987，P<0.01）、总体花费少（Z=-4.315，P<0.01），两组并发症发生率、护理满意度差异均无统计学意义（31.1%比14.9%与86.7%比95.7%，χ(2)=3.432、1.380，均P>0.05）。围手术期观察组患者VAS评分低于对照组。术后1个月内观察组患者关节功能明显优于对照组（t=4.458，P<0.01），术后3个月时两组差异无统计学意义（t=1.466，P=0.146）。术后各随访时间点两组患者生活质量差异均无统计学意义（t=1.293、1.227，均P>0.05）。 结论： 老年股骨颈骨折行人工股骨头置换患者围手术期应用ERAS方法可有效提高治疗效率，减少医疗费用，改善髋关节功能，值得推广应用。.
Keywords: Arthroplasty, replacement, hip; Enhanced recovery after surgery; Femoral neck fracture.