ABSTRACT
Objective To explore the application effect of enhanced recovery after surgery (ERAS) on elderly patients with intertrochanteric fractures during perioperative period.Methods Seventy-two elderly patients with unilateral fresh femoral intertrochanteric fractures admitted from July 2016 to August 2017 were selected.The patients were divided into ERAS group and regular group according to the treatment approach.In the ERAS group (n =35),there were 15 males and 20 females,aged 65-92 years (mean,78.6 years),with 19 patients on the left side and 16 on the right side.The injury causes included sprain in 25 patients and fall from height in 10.According to Evans classification,there were 4 patients with type 1,10 with type 2,12 with type 3 and 9 with type 4 in the ERAS group.Seventeen patients in the ERAS group (49％) had internal chronic diseases.In the regular group (n =37),there were 18 males and 19 females,aged 65-96 years (mean,77.6 years),with 21 patients on the left side and 16 on the right side.The injury causes included sprain in 26 patients and fall from height in 11.According to Evans classification,there were 4 patients with type 1,11 with type 2,13 with type 3,and 9 with type 4.Eighteen patients (49％) in the regular group had internal chronic diseases.The regular group adopted the conventional approach,while the ERAS group additionally adopted the concept of ERAS.The intraoperative blood loss,average blood transfusion volume,operation time,postoperative hospital stay,postoperative complication incidence,and postoperative hip function Harris score of the two groups were recorded.Results All patients were followed up for an average of 14.8 months (range,12-18 months).The patients acquired primary healing.The operation time was (40.4 ± 10.7)minutes,intraoperative blood loss (202.1 ± 57.0) ml,blood transfusion volume (0.82 ± 0.20) U and postoperative hospitalization time (6.1 ±0.8)days in ERAS group,which showed significant difference in comparison withregular group,with operation time,intraoperative blood loss,blood transfusion volume and postoperative hospitalization time for (50.5 ± 12.4) minutes,(260.3 ± 75.2) ml,(1.23 ± 0.34) U and (12.6 ±0.4)days respectively (P＜0.05 or 0.01).The incidence of complications was 32％ (12/37) in the regular group,and was 9％ (3/35) in ERAS group (P ＜ 0.05).Harris score of hip joint function was (95.3 ±0.9) points in ERAS group and (86.9 ± 0.7) points in regular group (P ＜ 0.05).Conclusions For elderly patients with intertrochanteric fractures during the perioperative period,application of ERAS can obviously reduce intraoperative blood loss and average blood transfusion,shorten the operation time and postoperative hospital stay,reduce the incidence of postoperative complications,and promote the rehabilitation of the hip function of the patients.
ABSTRACT
Objective To compare the difference of therapeutic effect of surgical operation and non-operation for acute damnification of elbow ulnar collateral ligament in rabbits.Methods A total of 81 New Zealand rabbits were randomly and equally divided into three groups(27 rabbits per group),ie,Group A(control group):the ulnar collateral ligaments of right elbow joint were only enclosed;Group B:the ulnar collateral ligaments of right elbow joint were severed and sutured;Group C:the ulnar collateral ligaments of right elbow joint were severed,without suture.The biomechanics was detected at time intervals of 3 and 6 weeks.Results Twelve weeks after transplantation,the displacements of the ligaments in Groups B and C were(6.06±0.4)mm and(7.72±0.44)mm,with statistical difference(P ＜ 0.05).The displacement of the ligaments in Group A was(5.87±0.46)mm,which was similar to that of Group B(P＞0.05).The maximum loads of the ligaments of Groups B and C were(68.23±5.64)N and (42.45±3.66)N respectively,with statistical difference(P＜0.05).The maximum load of the ligaments of Group A was(72.86±2.99)N,which was similar to that of Group B(P ＞ 0.05).The rigidities of the ligaments of Groups B and C were(11.33±1.52)N/mm and(5.52±0.67)N/mm respectively,with significant difference(P ＜ 0.05).The rigidities of the ligaments of Group A was(12.49±1.44)N/mm,which was similar to that of Group B(P ＞ 0.05).The power consumption of the ligaments of Groups B and C were(0.206±0.017)J and(0.163±0.013)J respectively,with statistical difference(P＜0.05).The power consumption of the ligaments of Group A was(0.213±0.010)J,which was similar to that of Group B(P＞0.05).Conclusion Surgical operation is more effective than the non-operation in dealing with acute damnification of the ulnar collateral ligaments of elbow ulnar collateral ligament in rabbits.