标题:快速康复结合人工髋关节置换术治疗高龄股骨转子间骨折疗效的Meta分析
作者:王明友 1,王洪平 2,兰玉平 2 1.大理大学临床医学院,云南 大理 671000;2.攀枝花市中心医院骨科,四川 攀枝花 617000
卷次:
2021年32卷6期
【摘要】 目的 系统评价快速康复结合人工髋关节置换术治疗高龄股骨转子间骨折的疗效。方法 计算机检索PubMed、The Cochrane library、EMBASE、Web of Science、CNKI、CBM、万方、维普等数据库,收集有关比较传统经典康复和ERAS在高龄股骨转子间骨折行人工髋关节置换术患者围术期应用的临床对照研究(CCT)或随机对照研究(RCT)的文献,检索年限为各数据库建库以来至 2020年7月10日。提取研究数据并进行研究质量评价,采用RevMan5.3进行Meta分析。结果 本研究纳入 8篇文献,共 760例患者(ERAS组 384例,Non-ERAS组 376例)。Meta分析结果显示:ERAS组显著缩短患者住院时间(MD=-4.15,95%CI:-6.43~-1.87),P<0.01),降低住院费用(MD=-0.59,95%CI:-0.69~-0.49,P<0.01);提高住院期间满意度(MD=12.28,95%CI:6.04~18.52,P<0.01);降低患者恶心呕吐、下肢深静脉血栓形成、肺部感染、关节功能障碍等并发症发生率(OR=0.13,95%CI:0.07~0.25,P<0.01);降低患者术后输血率(OR=0.17,95%CI:0.07~0.42,P<0.01);提高术后髋关节Harris评分(MD=3.26,95%CI:0.47~6.04,P<0.05)并降低术后NRS评分(MD=-1.34,95%CI:-2.17~-0.52,P<0.01)。结论 ERAS结合髋关节置换术在高龄股骨转子间骨折患者中能显著缩短住院时间并节约住院费用,降低患者恶心呕吐、下肢深静脉血栓形成、肺部感染及关节功能障碍等并发症发生率;同时降低术后输血率,提高术后髋关节Harris评分并降低术后NRS评分,提高患者满意度。
【关键词】 快速康复外科理念;高龄股骨转子间骨折;人工髋关节置换术;Meta分析
【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350(2021)06—0794—08
Effectiveness of Enhanced Recovery After Surgery on the perioperative period of artificial joint arthroplasty forelderly patients with intertrochanteric fracture of femur: a meta-analysis.
WANG Ming-you 1, WANG Hong-ping 2,LAN Yu-ping 2. 1. Department of Clinical Medicine, Dali University, Dali 671000, Yunnan, CHINA; 2. Department ofOrthopaedics, Panzhihua Central Hospital, Panzhihua 617000, Sichuan, CHINA
【Abstract】 Objective To evaluate the effectiveness of Enhanced Recovery After Surgery (ERAS) onthe perioperative period of artificial joint arthroplasty for elderly patients with intertrochanteric fracture of fe-mur. Methods PubMed, The Cochrane Library, EMBASE, Web of Science, CNKI, CBM, Wanfang, and VIPwere searched by computer. Literature was collected on controlled clinical trials (CCT) or randomized controlled tri-als (RCT) comparing the effect of conventional care and ERAS on the perioperative period of artificial joint arthroplastyfor elderly patients with intertrochanteric fracture of femur, with a retrieval period from their inception to July 10, 2020.Meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies met the inclusion criteria, in-volving a total of 760 patients (n=384 in ERAS group, n=376 in Non-ERAS group). Meta-analysis showed that patientsin ERAS group had significantly reduced the length of hospital stay (MD=-4.15, 95%CI: -6.43 to -1.87, P<0.01), re-duced hospitalization costs (MD=-0.59, 95% CI: -0.69 to -0.49, P<0.01), improved satisfaction during hospitalization(MD=12.28, 95% CI: 6.04 to 18.52, P<0.01), decreased incidence of complications such as postoperative nausea andvomiting, lower extremity deep venous thrombosis, lung infection, joint dysfunction (OR=0.13, 95%CI: 0.07 to 0.25,PP<0.01), reduced rate of postoperative blood transfusion (OR=0.17, 95%CI: 0.07 to 0.42, P<0.01), improved postopera-tive Harris scores (MD=3.26, 95%CI: 0.47 to 6.04, P<0.05), and decreased postoperative NRS scores (MD=-1.34, 95%CI: -2.17 to -0.52, P<0.01). Conclusion ERAS is effective and safe on the perioperative period of artificial joint ar-throplasty for elderly patients with intertrochanteric fracture of femur. It can significantly reduce the length of hospitalstay and save the hospitalization costs, and decrease the incidence of complications, reduce the rate of postoperativeblood transfusion and NRS scores, as well as improve the postoperative of Harris scores and patient satisfaction.
【Key words】 Enhanced Recovery After Surgery; Intertrochanteric fracture of femur for elderly patients; Artificialjoint arthroplasty; Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2021.06.031基金项目:2019年度四川省攀枝花市指导性科技计划项目(编号:2019ZD-S-1)
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