Efficacy of enhanced recovery after surgery on percutaneous pedicle screws treating thoracolumbar fractures
10.3760/cma.j.issn.1001-8050.2020.04.013
- VernacularTitle:加速康复外科护理对经皮椎弓根钉内固定治疗胸腰段脊柱骨折疗效的影响
- Author:
Fengxian JIANG
1
;
Bingchen SHAN
;
Mingxin GAO
;
Hongyin ZHAO
;
Xiangfeng CHEN
Author Information
1. 苏州大学附属第二医院脊柱外科 215004
- From:
Chinese Journal of Trauma
2020;36(4):353-359
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of enhanced recovery after surgery (ERAS) in percutaneous pedicle screw internal fixation treating thoracolumbar fracture patients.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with thoracolumbar fracture treated by percutaneous pedicle screw internal fixation at Second Hospital of Soochow University from October 2018 to April 2019. There were 42 males and 20 females, aged 27-59 years (mean, 43.9 years). Fracture site included T 11 in 4 patients, T 12 in 28, L 1 in 23 and L 2 in 7, and AO type contained type A1 in 40 patients, type A2 in 3, and type A3 in 19. Thirty-one patients were treated with ERAS nursing mode (ERAS group), and other 31 patients with routine nursing mode (control group). The postoperative recovery time of intestinal function, first time of expelling flatus and dejection time, hospitalization time, preoperative and postoperative pain visual analogue scale (VAS), Kolcaba comfort scale (GCQ), Oswestry disability index (ODI), incidence of abdominal distension, incidence of urinary tract infection, first wake up dizziness, urinary retention, and wound healing were compared between the two groups. Results:Period of follow-up for all patients was 3-6 months (mean, 4.5 months). Postoperative recovery time of intestinal function, first time of expelling flatus and dejection time in ERAS group were (7.2±2.0)hours, (10.7±3.7)hours and (26.7±6.4)hours, respectively, which were significantly decreased compared to control group [(19.2±5.6)hours, (22.5±5.1)hours, (72.5±12.4)hours] ( P<0.05). Hospitalization time was (4.7±1.3)days in ERAS group, shorter than that in control group [(5.9±1.5)days]. There was no significant difference in VAS preoperatively between the two groups ( P>0.05). VAS in ERAS group was (3.6±1.5)points, (2.8±0.8)points, (1.7±0.6)points at postoperative 1, 3 and 7 days, lower than that in control group [(4.6±1.3)points, (4.0±1.3)points, (2.7±0.9)points] ( P<0.05). GCQ score in ERAS group was (72.0±6.5)points, (75.0±11.1)points, (88.4±5.1)points and (89.3±4.5)points at 2 hours before operation and 2 hours, 1 days and 3 days after operation, which were higher than that in control groups [(54.0±7.2)points, (59.5±6.3)points, (62.7±5.9)points, (76.0±5.7)points] ( P<0.05). ODI in ERAS group was 37.3±5.8, 28.9±6.3 and 23.1±2.7 at 3 days, 1 month and 3 months after operation, which was markedly decreased compared to control group (44.9±7.9, 33.9±8.7, 30.3±5.3) ( P<0.05). Moreover, the incidence of abdominal distension, urinary tract infection and first wake up dizziness in ERAS group was 7%, 5%, 3%, respectively, reduced from that in control group (26%, 35%, 16%) ( P<0.05). No significant difference was observed in urinary retention wound healing of the two groups, but there was no difference in wound healing ( P>0.05). Conclusion:For thoracolumbar fracture patients treated with percutaneous pedicle screw internal fixation, ERAS has advantages over traditional nursing in attenuating pain, shortening hospitalization time, reducing postoperative abdominal distension and urinary tract infection, and accelerating functional recovery.
