关键词: 结核,骨关节, 膝关节, 外科手术, 加速康复外科

Abstract:

Objective: To evaluate the clinical effect of enhanced recovery after surgery (ERAS) management model in patients undergoing surgery for debriding knee joint tuberculosis lesion. Methods: A retrospective analysis was performed on clinical data of 35 patients who underwent knee joint tuberculosis debridement surgery under ERAS management (ERAS group) in the Department of Orthopedics of the Capital Medical University Affiliated Beijing Chest Hospital from January 2018 to October 2020. A control group was established with 35 knee joint tuberculosis debridement surgery patients who underwent non-ERAS management (non-ERAS group) consecutively enrolled from December 2015 to December 2017. The amount of blood loss, postoperative total drainage flow, postoperative deep vein thrombosis in lower extremities, first-stage incision healing and length of hospital stay were compared. Visual analogue scale (VAS) and hospital of special surgery (HSS) knee score were used to evaluate the degree of pain and knee function before and 8 weeks after surgery. Results: The average amount of blood loss in ERAS group ((65.0±12.2) ml) was significantly lower than that in non-ERAS group ((125.8±35.0) ml), the total postoperative drainage in ERAS group ((212.9±32.2) ml) was significantly lower than that in non-ERAS group ((408.6±51.9) ml),the hospitalization length in ERAS group ((19.1±2.4) days) was significantly shorter than that in non-ERAS group ((28.5±9.7) days), and the differences were all statistically significant (t were -5.085, -11.203 and -3.278, respectively,all P values <0.05). No postoperative lower extremity deep vein thrombosis occurred in ERAS group, and 2 cases occurred in non-ERAS group. First-stage healing occurred in 35 cases in ERAS group and 31 cases in non-ERAS group. At 8 weeks after surgery, average VAS score in ERAS group (2.6±0.8) was significantly lower than that before surgery (7.7±0.7), and average HSS score (77.4±3.8) was significantly higher than that before surgery (36.5±4.1), with statistically significant differences (t were 18.419 and -29.654, respectively, both P values <0.05). There were significant differences between the two scores before and after operation in the non-ERAS group (t were 14.807 and -12.771, respectively, all P values <0.05). At 8 weeks after surgery, average VAS score in ERAS group (2.6±0.8) was significantly lower than that in non-ERAS group (3.9±1.0), and average HSS score in ERAS group (77.4±3.8) was significantly higher than that in non-ERAS group (68.3±5.0), with statistically significant differences (t were -2.751 and 4.502, respectively,both P values <0.05). Conclusion: Appling the ERAS management in perioperative period for patients taking knee joint tuberculosis debridement surgery can alleviate postoperative symptoms, improve joint function, reduce blood loss and drainage, and shorten hospitalization time. ERAS management model can promote rapid recovery, reduce complications for patients.

Key words: Tuberculosis,osteoarticular, Knee joint, Surgical procedures,operative, Enhanced recovery after surgery