将加速康复外科理念应用于跟腱断裂微创治疗的效果观察

doi:10.3877/cma.j.issn.1673-9450.2023.03.007

中华损伤与修复杂志(电子版) ›› 2023, Vol. 18 ›› Issue (03) : 217 -222. doi: 10.3877/cma.j.issn.1673-9450.2023.03.007

论著

将加速康复外科理念应用于跟腱断裂微创治疗的效果观察

齐红哲, 彭军, 封国超, 刘光波, 赵宋华, 白克文, 周家宁, 李双成, 周雪峰^†(

), 陈华

100101　北京，战略支援部队特色医学中心骨科
100048　北京，中国人民解放军总医院第四医学中心骨科

收稿日期:2022-11-01 出版日期:2023-06-01
通信作者: 周雪峰
基金资助:
医药卫生军事医学研究课题(19ZX24); 军委科技委基础加强计划重点基础研究项目(2021-jcjqzd-264)

Clinical application of the concept of enhanced recovery after surgery in minimally invasive treatment for Achilles tendon rupture

Hongzhe Qi, Jun Peng, Guochao Feng, Guangbo Liu, Songhua Zhao, Kewen Bai, Jianing Zhou, Shuangcheng Li, Xuefeng Zhou^†(), Hua Chen

Department of Othopedics, Strategic Support Force Specialty Medical Center, Beijing 100101, China
Department of Orthopedics, the Fourth Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100048, China

Received:2022-11-01 Published:2023-06-01
Corresponding author: Xuefeng Zhou

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引用本文：

齐红哲, 彭军, 封国超, 刘光波, 赵宋华, 白克文, 周家宁, 李双成, 周雪峰, 陈华. 将加速康复外科理念应用于跟腱断裂微创治疗的效果观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(03): 217-222.

Hongzhe Qi, Jun Peng, Guochao Feng, Guangbo Liu, Songhua Zhao, Kewen Bai, Jianing Zhou, Shuangcheng Li, Xuefeng Zhou, Hua Chen. Clinical application of the concept of enhanced recovery after surgery in minimally invasive treatment for Achilles tendon rupture[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(03): 217-222.

目的

探讨加速康复外科(ERAS)理念下跟腱断裂微创治疗的临床效果。

方法

选择战略支援部队特色医学中心骨科2017年4月至2021年6月收治并手术的跟腱断裂患者44例，按照是否遵循ERAS理念分为ERAS组和常规组。分析两组患者性别、年龄、受伤侧别、BMI、术前受伤时间等基线资料，对比两组术前、术后医院焦虑抑郁量表(HADS)，术后12h VAS评分，随访6个月、末次随访时跟腱完全断裂评分(ATRS)、小腿患健侧围径比，分析ERAS理念在跟腱断裂微创手术中的应用效果。

结果

两组患者基线资料比较差异无统计学意义(P>0.05)。ERAS组术前、术后12 h HADS评分分别为5.0(4.0，6.0)分、6.0(5.0，6.0)分，均低于常规组[8.5(6.5，9.0)分、9.0(9.0，11.0)分]，差异有统计学意义(Z＝－3.904、－5.533，P＝0.000、0.000)。ERAS组术后12 h VAS评分[2.0(1.0，3.0)分]低于常规组[3.5(3.0，4.3)分]，差异有统计学意义(Z＝－3.829，P＝0.000)。ERAS组术后6个月ATRS评分与小腿患健侧围径比[(74.0±9.5)分、0.94±0.02]均优于常规组[(65.7±9.6)分、0.92±0.03]，差异有统计学意义(t＝－2.840、－2.510，P＝0.007、0.018)。末次随访时ERAS组ATRS评分、小腿患健侧围径比[(90.0±7.8)分、0.99(0.98，0.99)]与常规组[(86.6±8.4)分、0.98(0.98，0.99)]比较，差异无统计学意义(t＝－1.206，P＝0.235；Z＝－0.719，P＝0.472)。两组患者均未发生切口感染、腓肠神经损伤、再断裂、下肢深静脉血栓等并发症。

结论

ERAS理念应用于跟腱断裂治疗将有助于中青年患者更早回归生活、工作、运动，提高患者满意度，具有积极的社会效应，但对于中长期预后则无显著影响。

关键词: 跟腱, 腱损伤, 加速康复外科, 微创技术

Objective

To discuss the clinical effect of minimally invasive treatment for Achilles tendon under the concept of ERAS.

Methods

A total of 44 patients with Achilles tendon rupture admitted and operated in Department of Othopedics, Strategic Support Force Specialty Medical Center from April 2017 to June 2021 were included. According to whether the ERAS concept was followed, the patients were divided into ERAS group and conventional group. The baseline data such as gender, age, injury side, BMI, preoperative injury time of the two groups were analyzed. The anxiety and depression scale (HADS) before and after surgery, VAS score at 12 h after surgery, ATRS score and circumference diameter ratio of affected side and healthy side of calf at 6 months after surgery and last follow-up were compared between the two groups.

Results

There was no significant difference in baseline data between the two groups (P>0.05). The HADS score before and 12 h after operation of the ERAS group were 5.0(4.0, 6.0) and 6.0(5.0, 6.0), respectively, which were lower than those of the conventional group [8.5(6.5, 9.0), 9.0(9.0, 11.0)], with statistically significant differences (Z=-3.904, -5.533; P=0.000, 0.000). The VAS score at 12 h after surgery was 2.0(1.0, 3.0) in the ERAS group, which was lower than that of the conventional group [3.5(3.0, 4.3)], with statistically significant difference (Z=-3.829, P=0.000). At 6 months after surgery, ATRS score and circumference diameter ratio of affected side and healthy side of calf in the ERAS group [74.0±9.5, 0.94±0.02] were better than those of the conventional group [65.7±9.6, 0.92±0.03], with statistically significant differences (t=-2.840, -2.510; P=0.007, 0.018). At the last follow-up, there was no statistically significant difference in ATRS score and circumference diameter ratio of affected side and healthy side of calf between the ERAS group [(90.0±7.8), 0.99(0.98, 0.99)] and the conventional group [(86.6±8.4), 0.98(0.98, 0.99)] (t=-1.206, P=0.235; Z=-0.719, P=0.472). There were no complications such as incision infection, sural nerve injury, re-rupture, and deep vein thrombosis in the two groups.

Conclusion

The implementation of ERAS concept in Achilles tendon rupture will help young and middle-aged patients to return to life, work and exercise earlier, improve patient satisfaction, and has positive social effects, but has no significant impact on the mid-and long-term prognosis.

Key words: Achilles tendon, Tendon injury, Enhanced recovery after surgery, Minimally invasive technique

表1 两组患者一般资料比较

项目	常规组(n＝18)	ERAS组(n＝26)	t值/χ²值	P值
年龄(岁，±s)	40.6±8.2	37.1±8.2	1.366	0.179
BMI(kg/m²，±s)	23.6±2.6	24.3±2.9	－0.867	0.391
男性[例(%)]	17(94.4)	24(92.3)	－	1.000
左侧[例(%)]	10(55.5)	15(57.7)	0.020	0.888
术前受伤时间(d，±s)	3.7±1.9	3.0±1.4	1.374	0.177

表1 两组患者一般资料比较

项目	常规组(n＝18)	ERAS组(n＝26)	t值/χ²值	P值
年龄(岁，±s)	40.6±8.2	37.1±8.2	1.366	0.179
BMI(kg/m²，±s)	23.6±2.6	24.3±2.9	－0.867	0.391
男性[例(%)]	17(94.4)	24(92.3)	－	1.000
左侧[例(%)]	10(55.5)	15(57.7)	0.020	0.888
术前受伤时间(d，±s)	3.7±1.9	3.0±1.4	1.374	0.177

表2 两组患者住院及随访结果比较

分组	HADS评分[M(P₂₅，P₇₅)]			术后12 h VAS评分[M(P₂₅，P₇₅)]
分组	入院时	术前	术后12 h	术后12 h VAS评分[M(P₂₅，P₇₅)]
常规组	14.0(13.0，14.0)	8.5(6.5，9.0)	9.0(9.0，11.0)	3.5(3.0，4.3)
ERAS组	14.0(12.8，14.0)	5.0(4.0，6.0)	6.0(5.0，6.0)	2.0(1.0，3.0)
t值/Z值	－0.745	－3.904	－5.533	－3.829
P值	0.456	0.000	0.000	0.000
分组	ATRS评分(±s)		小腿患健侧围径比
分组	术后6个月	末次随访	术后6个月(±s)	末次随访[M(P₂₅，P₇₅)]
常规组	65.7±9.6	86.6±8.4	0.92±0.03	0.98(0.98，0.99)
ERAS组	74.0±9.5	90.0±7.8	0.94±0.02	0.99(0.98，0.99)
t值/Z值	－2.840	－1.206	－2.510	－0.719
P值	0.007	0.235	0.018	0.472

表2 两组患者住院及随访结果比较

分组	HADS评分[M(P₂₅，P₇₅)]			术后12 h VAS评分[M(P₂₅，P₇₅)]
分组	入院时	术前	术后12 h	术后12 h VAS评分[M(P₂₅，P₇₅)]
常规组	14.0(13.0，14.0)	8.5(6.5，9.0)	9.0(9.0，11.0)	3.5(3.0，4.3)
ERAS组	14.0(12.8，14.0)	5.0(4.0，6.0)	6.0(5.0，6.0)	2.0(1.0，3.0)
t值/Z值	－0.745	－3.904	－5.533	－3.829
P值	0.456	0.000	0.000	0.000
分组	ATRS评分(±s)		小腿患健侧围径比
分组	术后6个月	末次随访	术后6个月(±s)	末次随访[M(P₂₅，P₇₅)]
常规组	65.7±9.6	86.6±8.4	0.92±0.03	0.98(0.98，0.99)
ERAS组	74.0±9.5	90.0±7.8	0.94±0.02	0.99(0.98，0.99)
t值/Z值	－2.840	－1.206	－2.510	－0.719
P值	0.007	0.235	0.018	0.472

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Clinical application of the concept of enhanced recovery after surgery in minimally invasive treatment for Achilles tendon rupture

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Clinical application of the concept of enhanced recovery after surgery in minimally invasive treatment for Achilles tendon rupture