快速康复在强直性脊柱炎髋关节屈曲挛缩围手术期的应用

摘要

Objective To investigate the application of rapid rehabilitation concept in perioperative period of hip flexion contracture in ankylosing spondylitis.Methods A retrospective analysis of 22 cases of hip flexion contracture caused by ankylo-sing spondylitis who underwent one-stage bilateral hip release,femoral neck osteotomy,bone traction,and two-stage total hip re-placement(THA)in our hospital from 2012 to 2016 was performed.The patients were divided into the rapid rehabilitation group (12 cases from October 2014 to September 2016)and the traditional rehabilitation group(10 cases from January 2013 to September 2014)according to the intervention condition.Complications such as bleeding and blood transfusion, the interval between the two operation,the Harris score of the hip joint, the number of hospital stay, hip mobility, surgical incision infection and deep vein thrombosis in two groups were compared.Results Compared with the traditional group,in fast rehabilitation group,the average amount of one-stage blood loss was reduced by 122.3 mL, the amount of two-stage surgical blood loss reduced the average 243.8mL,the average hospitalization days decreased 7.3d,the two operation interval was decreased by 3.7d,the rate of blood transfusion was 56.67% lower,the Harris score and the flexion and extension of the hip joint and the degree of abduction in the rehabilitation group were better,and the difference was statistically significant.There was no significant difference in operative in-cision complications and deep vein thrombosis between the two groups.Conclusion The concept of rapid rehabilitation can reduce the amount of bleeding and the rate of blood transfusion,shorten the interval between two operations,improve the activity and func-tion of joints,and shorten the length of stay in the treatment of hip flexion contracture of ankylosing spondylitis.%目的 探讨快速康复理念在强直性脊柱炎髋关节屈曲挛缩手术围手术期中的应用.方法 回顾性分析2012年至2016年22例患者因强直性脊柱炎髋关节屈曲挛缩畸形在我院行一期行双侧髋关节松解、股骨颈截骨、骨牵引.二期行生物型全髋关节置换(total hip arthroplasty,THA).根据干预条件分为快速康复组(2014年10月至2016年9月,共12例)和传统康复组(2013年1月至2014年9月,共10例).比较两组患者两次手术出血及输血情况、手术间隔时间、出院时髋关节Harris评分、住院天数、髋关节活动度、手术切口感染及深静脉血栓等并发症的情况.结果 快速康复组与传统组相比,一期平均失血量减少122.3 mL,二期手术失血量平均减少243.8mL,平均住院天数减少7.3d,两次手术间隔减少3.7d,快速康复组输血率较传统组降低56.67%,出院时Harris评分及髋关节的屈伸、外展活动度快速康复组优于传统治疗组,且差异有统计学意义.两组患者在手术切口并发症及深静脉血栓形成方面无统计学差异.结论 快速康复理念在强直性脊柱炎髋关节屈曲挛缩手术中可明显减少出血量及降低输血率、缩短两次手术间隔时间,改善关节活动度及功能、缩短住院时间.