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加速康复外科在骨质疏松性椎体压缩骨折经皮椎体后凸成形术中的应用。

Application of Enhanced Recovery After Surgery in Patients with Osteoporotic Vertebral Compression Fractures Undergoing Percutaneous Kyphoplasty.

机构信息

Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Pain Management, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.

出版信息

World Neurosurg. 2024 Jan;181:e339-e345. doi: 10.1016/j.wneu.2023.10.052. Epub 2023 Oct 14.

Abstract

BACKGROUND

The enhanced recovery after surgery (ERAS) program helps patients recover faster and better, postoperatively. The aim of this retrospective study was to assess the clinical effectiveness of the ERAS program after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures.

METHODS

We enrolled patients with osteoporotic vertebral compression fracture who had undergone PKP between January 2019 and June 2021 and divided them into the control group (CG; n = 296), without the ERAS program, and the intervention group (IG; n = 306), with the ERAS program. The visual analog scale (VAS), Oswestry Disability Index (ODI), and Barthel Index scores of the 2 groups were compared on admission and 2 days and 1, 6, and 12 months postoperatively. Perioperative evaluation parameters included the mean surgery time, length of stay (LOS), and hospitalization expenses. In addition, postoperative complications were compared.

RESULTS

Regarding perioperative parameters, LOS and hospitalization expenses were significantly better in IG than in CG (P < 0.001), but the mean surgery time did not differ significantly (P > 0.05). The VAS, Barthel Index, and ODI scores were significantly better in IG than in CG at 2 days and 1 month postoperatively (P < 0.001). None of the clinical effectiveness parameters (VAS, Barthel Index, and ODI scores) differed between IG and CG at 6 or 12 months postoperatively. In addition, 141 patients in CG and 56 patients in IG experienced postoperative complications, including pressure ulcers, deep vein thrombosis, nausea and vomiting, and refracture (P = 0.970, P = 0.036, P < 0.001, P = 0.002 respectively).

CONCLUSIONS

For patients undergoing PKP, the ERAS program is a reliable and effective perioperative management method that can effectively reduce LOS, postoperative pain, and economic burden and promote recovery of patients.

摘要

背景

手术后加速康复(ERAS)方案有助于患者术后更快更好地康复。本回顾性研究旨在评估 ERAS 方案在骨质疏松性椎体压缩性骨折行经皮椎体后凸成形术(PKP)后的临床效果。

方法

我们纳入了 2019 年 1 月至 2021 年 6 月期间接受 PKP 的骨质疏松性椎体压缩性骨折患者,并将其分为对照组(CG;n=296)和干预组(IG;n=306)。比较两组患者入院时、术后 2 天、1 个月、6 个月和 12 个月的视觉模拟评分(VAS)、Oswestry 功能障碍指数(ODI)和 Barthel 指数评分。围手术期评估参数包括手术时间的平均值、住院时间(LOS)和住院费用。此外,比较了术后并发症。

结果

在围手术期参数方面,IG 的 LOS 和住院费用明显优于 CG(P<0.001),但手术时间无明显差异(P>0.05)。IG 在术后 2 天和 1 个月时的 VAS、Barthel 指数和 ODI 评分均明显优于 CG(P<0.001)。IG 和 CG 在术后 6 个月和 12 个月时的 VAS、Barthel 指数和 ODI 评分均无差异。此外,CG 中有 141 例患者和 IG 中有 56 例患者发生术后并发症,包括压疮、深静脉血栓形成、恶心呕吐和再骨折(P=0.970,P=0.036,P<0.001,P=0.002)。

结论

对于接受 PKP 的患者,ERAS 方案是一种可靠有效的围手术期管理方法,可有效缩短 LOS、减轻术后疼痛和经济负担、促进患者康复。

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