摘要
目的探讨人工全髋关节置换术(THA)日间模式治疗经严格筛选的股骨颈骨折患者的临床效益。方法回顾性分析武汉协和医院骨科2018年1月至2019年10月收治的符合纳入排除标准的股骨颈骨折患者62例。其中,28例于日间手术模式下行THA(日间手术组),34例于常规住院模式下行THA(住院手术组)。比较两组患者的骨折至手术时间、手术时长、术中失血量、住院天数、不良事件的发生、直接医疗费用、间接医疗费用、患者满意度、疼痛视觉模拟评分(VAS)以及Harris髋关节功能评分。结果所有患者均完成6个月随访。组间手术时间和术中失血量比较差异无统计学意义(P>0.05)。与住院手术组相比,日间手术组患者的骨折至手术时间和住院时间较短,术后并发症发生率较低,患者满意度较高,直接医疗费用和间接医疗费用均较低,差异均有统计学意义(Z=-6.219,P<0.001;Z=-6.736,P<0.001;χ^(2)=4.466,P=0.035;t=3.568,P=0.001;Z=-4.077,P<0.001;Z=-6.620,P<0.001)。日间手术组术后1 d,3 d,5 d VAS评分低于住院手术组(t=3.543,P=0.001;t=2.887,P=0.05;t=2.530,P=0.014)。日间手术组术后1个月和3个月Harris评分高于住院手术组(t=3.955,P<0.001;t=2.787,P=0.007)。结论THA日间模式治疗高选择性股骨颈骨折患者安全有效,患者住院时间短,并发症少,疗效好,费用低,满意度高。
Objective To investigate the clinical benefits of outpatient total hip arthroplasty in the treatment of highly selective patients with femoral neck fractures.Methods A retrospective study was performed in 62 cases of eligible femoral neck fractures in Wuhan Union Hospital from January 2018 to October 2019.28 patients underwent outpatient total hip arthroplasty were included into outpatient surgery group,the rest 34 patients were included in inpatient surgery group.The duration from injury to surgery,operative time,blood loss,length of stay,complications,direct medical costs,indirect medical costs,visual analog scale(VAS),patient satisfaction and Harris score were compared between the two groups.Results All patients were followed up for 6 months.There were no significant differences in operative time and blood loss between groups(P>0.05).Outpatient surgery group presented shorter time from fracture to surgery and hospi-talization stay,lower incidence of postoperative complications,higher patient satisfaction,lower direct and indirect medical costs than inpatient surgery group,differences were statistically signifcant(Z=-6.219,P<0.001,Z=-6.736,P<0.001,χ^(2)=4.466,P=0.035,t=3.568,P=0.001,Z=-4.077,P<0.001,Z=-6.620,P<0.001).VAS score at day 1,3 and 5 postoperatively in outpatient surgery group was significantly lower than that inpatient surgery group(t=3.543,P=0.001,t=2.887,P=0.05,t=2.530,P=0.014).Harris score at 1 month and 3 months after operation in outpatient surgery group was significantly higher than that in inpatient surgery group(t=3.955,P<0.001,t=2.787,P=0.007).Conclusion Outpatient total hip arthroplasty is safe and effective in the treatment of highly selective patients with femoral neck fractures,and can shorten hospitalization stay,reduce the medical costs and the incidence of complications,accelerate hip function recovery,improve the utilization of medical resources and patient satisfaction.
作者
史洋洋
贾杰
童伟
杨述华
许伟华
刘先哲
叶树楠
王晶
冯勇
田洪涛
Shi Yangyang;Jia Jie;Tong Wei;Yang Shuhua;Xu Weihua;Liu Xianzhe;Ye Shuman;Wang Jing;Feng Yong;Tian Hongtao(Department of Orthopedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 341200,China)
出处
《中华老年骨科与康复电子杂志》
2022年第2期74-79,共6页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
国家自然科学基金(81672235)。
关键词
全髋关节置换术
股骨颈骨折
日间手术
临床疗效
费用
Total hip arthroplasty
Femoral neck fracture
Outpatient surgery
Clinical efficacy
Cost
