标题：快速康复外科理念在骨科机器人导航下股骨颈骨折空心螺钉内固定术围手术期的应用

      作者：李玥娟，刘世伟，雷玲    (自贡市第四人民医院创伤关节外科，四川 自贡 643000)

      卷次： 2018年29卷19期

      【摘要】 目的 探讨快速康复外科理念在骨科机器人导航下股骨颈骨折空心螺钉内固定术围手术期的应用效果。方法 选择 2015年3月至2018年2月期间在自贡市第四人民医院创伤关节外科应用骨科机器人导航定位系统辅助完成股骨颈骨折空心螺钉内固定手术的患者58例作为研究对象，根据住院号单双数随机分为对照组和观察组各 29例，对照组给予常规护理，观察组给予快速康复护理，比较两组患者术后不同时间疼痛程度、并发症发生率、平均住院时间和平均住院费用。结果 观察组患者术后 6 h、24 h、48 h、72 h 的NRS疼痛评分分别为(4.10±0.62)分、(2.93±0.70)分、(2.14±0.35)分、(1.10±0.41)分，低于对照组的(7.07±0.70)分、(4.24±0.64)分、(3.55±0.69)分、(2.66±0.61)分，差异均有统计学意义(P<0.05)；观察组患者术后肺部感染、泌尿系感染、深静脉血栓、便秘等并发症的发生率分别为 3.45%、0、0和 3.45%，低于对照组的 20.69%、13.79%、17.24%和 20.69%，差异均有统计学意义(P<0.05)；观察组患者的平均住院时间为(9.97±1.32) d，平均住院费用为(2.61±0.17)万元，低于对照组的(15.03±1.32) d和(3.08±0.09)万元，差异均有统计学意义(P<0.05)。结论 将快速康复外科理念应用于机器人导航下股骨颈骨折空心螺钉内固定术围手术期护理可显著减轻患者的疼痛，降低并发症的发生率，缩短患者的住院时间，降低住院费用，值得临床推广。
      【关键词】 快速康复外科；机器人导航；股骨颈骨折；护理
      【中图分类号】 R687.3 【文献标识码】 A 【文章编号】 1003—6350（2018）19—2801—04

Application of fast-track surgery concept in perioperative period of cannulated screw fixation for femoral neckfracture under robot navigation in Department of Orthopedics.
LI Yue-juan, LIU Shi-wei, LEI Ling. Department ofTrauma and Joint Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, CHINA
【Abstract】 Objective To investigate the effect of fast-track surgery (enhanced recovery programs) in the peri-operative period of hollow screw fixation for femoral neck fracture guided by orthopaedic robot. Methods FromMarch 2015 to February 2018, 58 cases of femoral neck fracture hollow screw internal fixation operated by robot naviga-tion and positioning system in Department of Orthopedics, Zigong Fourth People's Hospital were selected and divided in-to the control group and the observation group according to the number of hospitalization number, with 29 cases in eachgroup. The group was given routine nursing, and the observation group was given rapid rehabilitation nursing. The paindegree, the incidence of complications, the average time of hospitalization and the average hospitalization cost were com-pared between the two groups at different time points. Results The numerical rating scale (NRS) pain scores of 6 h, 24 h,48 h and 72 h in the observation group were (4.10±0.62), (2.93±0.70), (2.14±0.35), (1.10±0.41), respectively, whichwere significantly lower than corresponding (7.07±0.70), (4.24±0.64), (3.55±0.69), (2.66±0.61) of the control group (P<0.05). The incidence of postoperative complications such as pulmonary infection, urinary tract infection, deep venousthrombosis and constipation in the observation group were 3.45%, 0, 0 and 3.45% respectively, which were significantlylower than corresponding 20.69%, 13.79%, 17.24% and 20.69% of the control group (P<0.05). The average hospitaliza-tion time average hospitalization fee in the observation group were (9.97±1.32) d and (2.61±0.17)×104 yuan, which weresignificantly lower than (150.03±1.32) days and (3.08±0.09)×104 yuan in the control group (P<0.05). Conclusion Theapplication of the concept of fast-track surgery to the perioperative nursing of the internal fixation of the femoral neckfracture under the robot navigation can significantly reduce the pain of the patients, reduce the incidence of complica-tions, shorten the time of hospitalization and reduce the cost of hospitalization, which is worthy of clinical promotion.
      【Key words】 Fast-track surgery; Robot navigation; Femoral neck fracture; Nursing·护 理·doi:10.3969/j.issn.1003-6350.2018.19.042