快速通道髋膝关节置换术后获得优异的 PROM 结果：无术后限制的快速通道手术验证的队列研究。
Excellent PROM results after fast-track hip and knee arthroplasty with no postoperative restrictions: a cohort study validation of fast-track surgery without postoperative restrictions.
机构信息
Department of Orthopaedic Surgery, Stavanger University Hospital, Stavanger, Norway.
Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
出版信息
BMC Musculoskelet Disord. 2022 Apr 5;23(1):324. doi: 10.1186/s12891-022-05276-y.
BACKGROUND
Fast-track hip and knee arthroplasty (HA and KA) has been increasingly common over the last decade. In the same time period, there was a strong trend toward less restrictive mobilization. However, few reports have been published on combining these novel programs while measuring the postoperative results by patient-reported outcome measures (PROMs). Descriptions of fast-track surgery programs and their results are warranted.
METHODS
The aim of this retrospective cohort study was to examine if it is possible to achieve excellent PROM results for hip and knee arthroplasty patients in a fast-track pathway without postoperative restrictions. During 2014-2017, the stepwise introduction of a PROM program was implemented at Stavanger University Hospital for all scheduled HA and KA patients, with preoperative assessments and postoperative follow-ups at the outpatient clinic. Standardized information with a focus on early mobilization and no postoperative restrictions was also initiated for the same patients. The generic EuroQol questionnaire (EQ-5D) and either the Hip or Knee disability/injury and Osteoarthritis Outcome Score (HOOS or KOOS) were used.
RESULTS
PROM response rates varied from 80 to 99%. The median (interquartile range) change from preoperative to one-year postoperative results were as follows for HA and KA patients, respectively: pain, 55 (43-68) and 47 (31-61); other symptoms, 50 (40-65) and 36 (19-50); function in daily living, 54 (41-65) and 44 (31-55); function in sports and recreation, 56 (38-75) and 40 (15-64); joint-related quality of life, 69 (50-81) and 56 (38-75). The length of stay (LOS) was reduced by 1.9 days (mean), corresponding to a 40% reduction for HA patients and a 37% reduction for KA patients.
CONCLUSIONS
We found excellent PROM results after fast-track HA and KA with no postoperative restrictions. We believe that a fast-track program focusing on mobilization without any postoperative restrictions is superior for most patients, but further comparative studies are warranted.
背景
在过去十年中，快速通道髋关节和膝关节置换术（HA 和 KA）越来越普遍。与此同时，限制活动的趋势也越来越强。然而，很少有报道将这些新方案结合起来，并通过患者报告的结果测量术后结果（PROMs）。有必要描述快速通道手术方案及其结果。
方法
本回顾性队列研究的目的是检验在没有术后限制的情况下，快速通道途径是否可以为髋关节和膝关节置换患者获得出色的 PROM 结果。在 2014 年至 2017 年期间，斯塔万格大学医院对所有计划接受 HA 和 KA 的患者逐步实施了 PROM 方案，在门诊进行术前评估和术后随访。还为同一批患者启动了标准化信息，重点关注早期活动和无术后限制。使用通用的 EuroQol 问卷（EQ-5D）和髋关节或膝关节残疾/损伤和骨关节炎结果评分（HOOS 或 KOOS）。
结果
PROM 应答率从 80%到 99%不等。HA 和 KA 患者术前至一年术后结果的中位数（四分位距）变化分别为：疼痛，55（43-68）和 47（31-61）；其他症状，50（40-65）和 36（19-50）；日常生活功能，54（41-65）和 44（31-55）；运动和娱乐功能，56（38-75）和 40（15-64）；关节相关生活质量，69（50-81）和 56（38-75）。住院时间（LOS）缩短了 1.9 天（平均值），HA 患者减少了 40%，KA 患者减少了 37%。
结论
我们发现快速通道 HA 和 KA 术后没有术后限制，PROM 结果非常出色。我们认为，关注活动而没有任何术后限制的快速通道方案对大多数患者更有利，但需要进一步的比较研究。
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