Abstract:

Objective　To evaluate the effect of diagnosis and treatment pathways based on enhanced recovery after surgery (ERAS) for patients with ankle fracture during perioperative period. Methods　One hundred patients with ankle fracture admitted to Department of Trauma Orthopedics, People's Hospital of Hechi City from June 2019 to June 2020 were selected, and were divided into an ERAS group and a control group by the random number table method, with 50 cases in each group. There were 28 males and 22 females in the control group, and they were (47.25±13.48) years old. There were 24 males and 26 females in the ERAS group, and they were (46.37±11.69) years old. The control group was given routine perioperative intervention, and the observation group developed diagnosis and treatment pathways based on ERAS. The operation times, intraoperative bleeding volumes, postoperative hospital stays, fracture healing times, American Orthopedic Foot and Ankle Society (AOFAS) scores, Baird-Jackson scores, Visual Analogue Scale (VAS) scores, and incidences of complications were compared between the two groups.The measurement data were compared by independent-sample t test and paired t test, and the enumeration data by χ² test. Results　The operation time, intraoperative bleeding volume, postoperative hospital stay, and fracture healing time were (96.45±12.89) min, (52.12±10.48) ml, (7.44±2.18) d, and (12.05±1.33) weeks in the ERAS group, and were (108.62±15.01) min, (64.35±11.92) ml, (9.12±3.04) d, and (13.84±2.12) weeks in the control group, with statistical differences (t=4.898, 7.725, 5.562, and 5.873; all P<0.001). Three months after the surgery, the scores of AOFAS, Baird-Jackson, and VAS were (56.82±5.88), (88.05±9.32), and (1.51±0.39) in the ERAS group, and were (51.34±4.92), (79.84±8.12), and (2.39±0.54) in the control group, with statistical differences (t=3.375, 3.289, and 8.272; all P<0.001). The incidence of complications in the ERAS group was lower than that in the control group [2% (1/50) vs. 14% (7/50); χ²=4.891, P=0.027]. Conclusion　Diagnosis and treatment pathways based on ERAS for patients with ankle fracture during perioperative period can significantly reduce intraoperative bleeding, shorten operation time and hospital stay, promote ankle function recovery, and reduce complications.

Key words: Enhanced recovery after surgery, Ankle fracture, Perioperative period

摘要：

目的　探讨加速康复外科（enhanced recovery after surgery，ERAS）诊疗路径在踝关节骨折患者围术期的应用效果。方法　选取2019年6月至2020年6月河池市人民医院创伤骨科收治的100例踝关节骨折患者，随机数字表法将其分为ERAS组（50例）和对照组（50例）。对照组男性28例，女性22例，年龄（47.25±13.48）岁。ERAS组男性24例，女性26例，年龄（46.37±11.69）岁。对照组给予围术期常规干预，ERAS组制定踝关节骨折ERAS诊疗路径。比较两组手术时间、术中出血量、术后住院时间、骨折愈合时间、美国矫形足踝协会评分系统（AOFAS）评分、Baird-Jackson评分、疼痛视觉模拟评分（VAS）及并发症发生率。计量资料采用独立样本t检验和配对t检验；计数资料采用χ²检验。结果　ERAS组手术时间（96.45±12.89）min、术中出血量（52.12±10.48）ml、术后住院时间（7.44±2.18）d及骨折愈合时间（12.05±1.33）周，均显著少于对照组的（108.62±15.01）min、（64.35±11.92）ml、（9.12±3.04）d、（13.84±2.12）周（t=4.898、7.725、5.562、5.873，均P<0.001）。术后3个月，ERAS组AOFAS评分（56.82±5.88）分、Baird-Jackson评分（88.05±9.32）分，均高于对照组的（51.34±4.92）分、（79.84±8.12）分，VAS评分（1.51±0.39）分，低于对照组的（2.39±0.54）分（t=3.375、3.289、8.272，均P<0.001）。ERAS组并发症发生率显著低于对照组［2%（1/50）比14%（7/50），χ²=4.891，P=0.027］。结论　ERAS诊疗路径在踝关节骨折患者围术期的应用，能明显减少术中出血，缩短手术时间及住院时间，促进踝关节功能恢复，降低并发症风险。

关键词: 加速康复外科, 踝关节骨折, 围术期