Abstract:

Objective　To explore and analyze the practice and application of enhanced recovery after surgery (ERAS) of integrated traditional Chinese and western medicine in perioperative period of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods　This was a prospective study. Eighty-nine patients who underwent perioperative treatment of MIS-TLIF in Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Guangzhou Medical University from January 2018 to January 2022 were selected and were divided into an ERAS of integrated traditional Chinese and western medicine group (ERAS group; 46 cases) and a traditional group (43 cases) by drawing lots. There were 20 males and 26 females in the ERAS group; they were (63.76±8.42) years old. There were 19 males and 24 females in the traditional group; they were (62.30±9.48) years old. The scores of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) in different perioperative periods, incidences of postoperative complications, and patient satisfactions were compared between the two groups. χ² and t tests were applied. Results　There were statistical differences in the scores of VAS 1, 7, and 30 d after the surgery between these two groups (t=-2.451, -2.097, and -2.305; all P<0.05). Thirty days after the surgery, the scores of ODI in both groups decreased; the score in the ERAS group was lower than that in the control group [(11.8±4.28)) vs. (13.9±3.83)], with a statistical difference (t=-2.383, P<0.05). The incidence of postoperative complications in the ERAS group was lower than that in the control group [13.0% (6/46) vs. 32.6% (14/43)], with a statistical difference (χ²=4.858, P<0.05). Conclusions　The ERAS of integrated traditional Chinese and western medicine has been widely used; it effectively integrates and optimizes the perioperative treatment measures and procedures of various disciplines, significantly improves patient compliance and clinical efficacy of surgery, and shortens postoperative recovery period. It has high patient satisfaction with treatment. Therefore, it is worthy of clinical application.

Key words:

Minimally invasive transforaminal lumbar interbody fusion, Integration of traditional Chinese and western medicine, Enhanced recovery after surgery, Perioperative period, Practice and application

摘要：

目的　探讨中西医结合外科快速康复理念在微创经椎间孔入路的腰椎椎间融合术（MIS-TLIF）围手术期中的实践运用。方法　采用前瞻性研究，选取广州医科大学附属中医医院骨伤科2018年1月至2022年1月进行MIS-TLIF围手术期治疗患者89例，应用抽签方法分为两组。中西医结合外科快速康复组（ERAS组）46例，男20例，女26例，年龄（63.76±8.42）岁；传统组43例，男19例，女24例，年龄（62.30±9.48）岁，比较两组患者围手术不同时期的视觉模拟评分量表（VAS）评分、Oswestry功能障碍指数问卷表（ODI）评分、术后并发症发生率，以及患者满意度。统计学方法采用χ²检验、t检验。结果　ERAS组与传统组术后1 d、7 d、30 d患者VAS评分比较，差异均有统计学意义（t=-2.451、-2.097、-2.305，均P<0.05）。术后30 d，两组患者的ODI评分均有所降低，ERAS组评分为（11.8±4.28）分，传统组评分为（13.9±3.83）分，ERAS组治疗后的ODI评分低于传统组，差异有统计学意义（t=-2.383，P=0.019）。ERAS组、传统组总的不良反应发生率分别为13.0%（6/46）、32.6%（14/43），差异有统计学意义（χ²=4.858，P<0.05）。结论　中西医结合ERAS理念和措施得到广泛应用，有效整合优化了各学科围手术期的处理措施和流程，对患者的依从性、手术临床疗效和缩短术后康复期都有显著的提高效应，具有较高的患者治疗满意度，值得临床推广应用。

关键词:

微创经椎间孔入路的腰椎椎间融合术, 中西医结合, 外科快速康复, 围手术期, 实践运用