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用于微创治疗跟腱断裂的术后加速康复方案:前瞻性单中心随机研究。

Enhanced recovery after surgery protocols for minimally invasive treatment of Achilles tendon rupture: Prospective single-center randomized study.

作者信息

Yan Xiu-Jie, Zhang Wei-Hong

机构信息

School of Health and Nursing, Zhengzhou University, Zhengzhou 450000, Henan Province, China.

出版信息

World J Orthop. 2024 Dec 18;15(12):1191-1199. doi: 10.5312/wjo.v15.i12.1191.

Abstract

BACKGROUND

Achilles tendon rupture is a common orthopedic injury, with an annual incidence of 11-37 per 100000 people, significantly impacting daily life. Minimally invasive surgery, increasingly favored for its reduced risks and comparable fixation strength to open surgery, addresses these challenges. Despite advantages like accelerated recovery, perioperative care poses emotional support, pain management, and rehabilitation challenges, impacting treatment efficacy and patient experience. To address these gaps, this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery, aiming to develop personalized, standardized care guidelines for broader implementation.

AIM

To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery, providing evidence-based early recovery indicators.

METHODS

This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups. The experimental group received perioperative rapid rehabilitation nursing care, while the control group received standard care. The primary outcome measure was the Oswestry disability index score, with secondary outcomes including quality of life, Barthel index, patient satisfaction with nursing, incidence of complications, and rehabilitation adherence. Statistical analysis included appropriate methods to compare outcomes between groups. The study was conducted in a specific setting, utilizing a randomized controlled trial design.

RESULTS

All 160 patients completed the follow-up. The experimental group showed significantly greater improvements in key efficacy indicators: Postoperative Oswestry disability index score (8.688 18.88, < 0.0001), quality of life score (53.25 38.99, < 0.0001), and Barthel index (70.44 51.63, < 0.0001). The experimental group had a lower incidence of deep vein thrombosis (1.25% 10.00%, = 0.0339) with a relative risk of 0.1250 (95% confidence interval: 0.02050-0.7421). Infection rates were lower in the experimental group (2.50% 11.25%, = 0.0564). Hospital stay (5.40 days 7.26 days, < 0.0001) and postoperative bed rest (3.34 days 5.42 days, < 0.0001) were significantly shorter. Patient satisfaction was 100% in the experimental group 87.50% in the control group ( = 0.0031).

CONCLUSION

The rapid rehabilitation intervention significantly reduced pain, shortened hospital stays, and lowered complication rates, improving joint function and patient satisfaction.

摘要

背景

跟腱断裂是一种常见的骨科损伤,年发病率为每10万人中11 - 37例,对日常生活有显著影响。微创手术因其风险降低且固定强度与开放手术相当而越来越受到青睐,可应对这些挑战。尽管具有加速康复等优势,但围手术期护理在情感支持、疼痛管理和康复方面仍面临挑战,影响治疗效果和患者体验。为解决这些差距,本研究调查了快速康复方案对微创跟腱手术恢复结果的疗效,旨在制定个性化、标准化的护理指南以更广泛地实施。

目的

评估以护理为主导的微创跟腱修复手术快速康复方案,提供基于证据的早期恢复指标。

方法

本研究纳入160例行通道辅助微创跟腱修复术的患者,随机分为实验组和对照组。实验组接受围手术期快速康复护理,而对照组接受标准护理。主要结局指标是Oswestry功能障碍指数评分,次要结局包括生活质量、Barthel指数、患者对护理的满意度、并发症发生率和康复依从性。统计分析采用适当方法比较组间结局。该研究在特定环境中进行,采用随机对照试验设计。

结果

160例患者均完成随访。实验组在关键疗效指标上有显著更大改善:术后Oswestry功能障碍指数评分(8.688±18.88,P<0.0001)、生活质量评分(53.25±38.99,P<0.0001)和Barthel指数(70.44±51.63,P<0.0001)。实验组深静脉血栓形成发生率较低(1.25% vs 10.00%,P = 0.0339),相对风险为0.1250(95%置信区间:0.02050 - 0.7421)。实验组感染率较低(2.50% vs 11.25%,P = 0.0564)。住院时间(5.40天vs 7.26天,P<0.0001)和术后卧床休息时间(3.34天vs 5.42天,P<0.0001)显著缩短。实验组患者满意度为100%,对照组为87.50%(P = 0.0031)。

结论

快速康复干预显著减轻疼痛、缩短住院时间并降低并发症发生率,改善关节功能和患者满意度。

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