亚洲青少年特发性脊柱侧凸患者加速康复方案的可行性和结果。
Feasibility and Outcome of an Accelerated Recovery Protocol in Asian Adolescent Idiopathic Scoliosis Patients.
机构信息
Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Military Hospital, Colombo, Sri Lanka.
出版信息
Spine (Phila Pa 1976). 2017 Dec 15;42(24):E1415-E1422. doi: 10.1097/BRS.0000000000002206.
STUDY DESIGN
A prospective cohort study.
OBJECTIVE
The aim of this study was to determine the feasibility of an accelerated recovery protocol for Asian adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF).
SUMMARY OF BACKGROUND DATA
There has been successful implementation of an accelerated recovery protocol for AIS patients undergoing PSF in the western population. No similar studies have been reported in the Asian population.
METHODS
Seventy-four AIS (65 F, 9 M) patients scheduled for PSF surgery were recruited. The accelerated protocol encompasses preoperative regime, preoperative day of surgery counseling, intraoperative strategies, an accelerated postoperative rehabilitation and pain management regime. All patients were operated using a dual attending surgeon strategy. Outcome measures included pain scores at five time intervals, length of stay, and detailed recovery milestones. Any complications or readmissions during the first 4 months postoperative period were recorded.
RESULTS
Mean duration of operation was 2.2 ± 0.3 hours with a mean blood loss of 824.3 ± 418.2 mL. No patients received allogenic blood transfusion. The mean length of stay was 3.6 ± 0.6 days. Surgical wound pain score was 6.4 ± 2.1 at 12 hours, which reduced to 5.0 ± 2.0 at 60 hours. Abdominal pain peaked at 36 hours with pain scores 2.4 ± 2.9. First liquid intake was at 5.2 ± 7.5 hours, urinary catheter removal at 18.7 ± 4.8 hours, sitting up at 20.6 ± 9.1 hours, ambulation at 27.2 ± 0.5 hours, consumption of solid food at 32.2 ± 0.5 hours, first flatus at 39.0 ± 0.7 hours, and first bowel movement at 122.1 ± 2.0 hours. The complication rate was 1.4% due to superficial wound infection with one patient failed to comply with the accelerated protocol.
CONCLUSION
An accelerated recovery protocol following PSF for AIS is feasible without increasing the complication or readmission rates. The total length of stay was 3.6 days and this is comparable with the outcome in western population.
LEVEL OF EVIDENCE
研究设计
前瞻性队列研究。
目的
本研究旨在确定加速康复方案在亚洲青少年特发性脊柱侧凸（AIS）患者后路脊柱融合术（PSF）中的可行性。
背景资料总结
在西方人群中，成功实施了 AIS 患者 PSF 的加速康复方案。在亚洲人群中尚未有类似的研究报告。
方法
招募了 74 例 AIS（65 例女性，9 例男性）患者进行 PSF 手术。加速方案包括术前方案、手术当天的术前咨询、术中策略、加速术后康复和疼痛管理方案。所有患者均采用双主治医生策略进行手术。术后 4 个月内记录疼痛评分、住院时间和详细的康复里程碑，以及任何并发症或再入院情况。
结果
手术平均时间为 2.2±0.3 小时，平均失血量为 824.3±418.2 毫升。无患者接受异体输血。平均住院时间为 3.6±0.6 天。手术伤口疼痛评分在 12 小时时为 6.4±2.1，在 60 小时时降至 5.0±2.0。腹部疼痛在 36 小时达到峰值，疼痛评分为 2.4±2.9。首次液体摄入时间为 5.2±7.5 小时，导尿管拔出时间为 18.7±4.8 小时，坐起时间为 20.6±9.1 小时，步行时间为 27.2±0.5 小时，固体食物摄入时间为 32.2±0.5 小时，首次排气时间为 39.0±0.7 小时，首次排便时间为 122.1±2.0 小时。并发症发生率为 1.4%，系 1 例患者因浅表伤口感染且未遵守加速方案导致。
结论
后路脊柱融合术治疗 AIS 后的加速康复方案是可行的，不会增加并发症或再入院率。总住院时间为 3.6 天，与西方人群的结果相当。
证据等级
4 级。
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