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[摘要] 目的 探讨在高龄股骨转子间骨折围手术期应用快速康复外科理念的方法和效果。 方法 回顾性分析2016年1月～2017年1月应用快速康复外科理念行围手术期处理的83例老年股骨转子间骨折患者的临床资料。观察患者满意度、术后疼痛、术后输血、并发症及手术疗效。 结果 应用快速康复理念的患者术后疼痛缓解明显，术后并发症发生率为8.4%（7/83），输血率为6.0%（5/83），术后患者满意率为96.4%（80/83），术后3个月Harris髋关节功能评分优良率为90.4%（75/83）。 结论 快速康复外科理念在高龄股骨转子间骨折患者围手术期应用可提高患者满意度及舒适度、减少手术并发症发生，促进患者快速康复。
[关键词] 股骨转子间骨折；快速康复外科；股骨近端防旋髓内钉
[中图分类号] R683 [文献标识码] B [文章编号] 1673-9701（2018）31-0073-04
Experience of the application of rapid rehabilitation surgery concept in the perioperative period of elderly patients with intertrochanteric fractures
WANG Bei1 XIANG Liang2
1.Department of Hand and Foot Surgery， Affiliated Nanhua Hospital，University of South China， Hengyang 421002，China； 2.Department of Joint and Sports Medicine， Affiliated Nanhua Hospital， University of South China， Hengyang 421002， China
[Abstract] Objective To investigate the method and effect of applying the concept of rapid rehabilitation surgery in the perioperative period of elderly patients with intertrochanteric fractures. Methods The clinical data of 83 elderly patients with intertrochanteric fractures who underwent perioperative management with the concept of rapid rehabilitation surgery from January 2016 to January 2017 were retrospectively analyzed. The patients’ satisfaction， postoperative pain， postoperative blood transfusion， complications， and surgical efficacy were observed. Results The postoperative pain relief was obvious in patients who applied the concept of rapid recovery. The postoperative complication rate was 8.4%（7/83）， and the transfusion rate was 6.0%（5/83）. The postoperative patient satisfaction rate was 96.4%（80/83）. The excellent and good rate of Harris hip function score was 90.4%（75/83） 3 months after surgery. Conclusion The concept of rapid rehabilitation surgery in the perioperative period of elderly patients with intertrochanteric fractures can improve patients’ satisfaction and comfort， reduce the occurrence of surgical complications， and promote rapid recovery of patients.
[Key words] Intertrochanteric fractures； Rapid rehabilitation surgery； Proximal femoral nail antirotation
2001年丹麥医生Kehlet最早提出快速康复外科（fast-track surgery，FTS）的概念，是指使用各种有循证医学证据的措施来进行围手术期处理，以减少围手术期的应激反应，降低手术风险、提高手术安全性和患者满意度，加速术后恢复并使患者得到更好的治疗效果。目前已被广泛应用于各外科领域。近年来，在骨科领域的髋膝关节置换手术中逐渐应用并达成专家共识[1]。股骨转子间骨折好发于老年人，因保守治疗需长期卧床，并发症多，目前多主张早期行内固定手术治疗，治疗的目的是尽可能避免或减少并发症，早期下地活动，尽早恢复关节功能。本研究选取83例在我院接受内固定手术治疗高龄股骨转子间骨折患者，应用快速康复理念进行围手术期处理，获得了满意的效果，现报道如下。
[关键词] 股骨转子间骨折；快速康复外科；股骨近端防旋髓内钉
[中图分类号] R683 [文献标识码] B [文章编号] 1673-9701（2018）31-0073-04
Experience of the application of rapid rehabilitation surgery concept in the perioperative period of elderly patients with intertrochanteric fractures
WANG Bei1 XIANG Liang2
1.Department of Hand and Foot Surgery， Affiliated Nanhua Hospital，University of South China， Hengyang 421002，China； 2.Department of Joint and Sports Medicine， Affiliated Nanhua Hospital， University of South China， Hengyang 421002， China
[Abstract] Objective To investigate the method and effect of applying the concept of rapid rehabilitation surgery in the perioperative period of elderly patients with intertrochanteric fractures. Methods The clinical data of 83 elderly patients with intertrochanteric fractures who underwent perioperative management with the concept of rapid rehabilitation surgery from January 2016 to January 2017 were retrospectively analyzed. The patients’ satisfaction， postoperative pain， postoperative blood transfusion， complications， and surgical efficacy were observed. Results The postoperative pain relief was obvious in patients who applied the concept of rapid recovery. The postoperative complication rate was 8.4%（7/83）， and the transfusion rate was 6.0%（5/83）. The postoperative patient satisfaction rate was 96.4%（80/83）. The excellent and good rate of Harris hip function score was 90.4%（75/83） 3 months after surgery. Conclusion The concept of rapid rehabilitation surgery in the perioperative period of elderly patients with intertrochanteric fractures can improve patients’ satisfaction and comfort， reduce the occurrence of surgical complications， and promote rapid recovery of patients.
[Key words] Intertrochanteric fractures； Rapid rehabilitation surgery； Proximal femoral nail antirotation
2001年丹麥医生Kehlet最早提出快速康复外科（fast-track surgery，FTS）的概念，是指使用各种有循证医学证据的措施来进行围手术期处理，以减少围手术期的应激反应，降低手术风险、提高手术安全性和患者满意度，加速术后恢复并使患者得到更好的治疗效果。目前已被广泛应用于各外科领域。近年来，在骨科领域的髋膝关节置换手术中逐渐应用并达成专家共识[1]。股骨转子间骨折好发于老年人，因保守治疗需长期卧床，并发症多，目前多主张早期行内固定手术治疗，治疗的目的是尽可能避免或减少并发症，早期下地活动，尽早恢复关节功能。本研究选取83例在我院接受内固定手术治疗高龄股骨转子间骨折患者，应用快速康复理念进行围手术期处理，获得了满意的效果，现报道如下。