Perioperative optimization strategy for minimally invasive treatment of intertrochanteric femoral fractures in elderly patients using proximal femoral nail antirotation (PFNA) based on the enhanced recovery after surgery (ERAS) concept
基于“ERAS”理念的股骨近端防旋髓内钉（PFNA）微创治疗高龄股骨转子间骨折的围术期优化策略

摘要

目的 探讨基于加速康复外科（ERAS）理念的围术期医疗优化策略在PFNA微创治疗高龄股骨转子间骨折中的临床应用价值。方法 回顾性选取100例高龄（≥80岁）股骨转子间骨折患者，均行PFNA微创治疗，根据围术期管理方案分为对照组（n=48，常规诊疗）与观察组（n=52，ERAS优化方案）。对比两组手术指标、术后康复、并发症及临床疗效。结果 两组手术时间、术中出血量差异无统计学意义（P＞0.05）；观察组术后首次下床活动时间、住院时间均短于对照组，术后24h、48h、72h VAS评分均低于对照组（P＜0.05）。观察组并发症总发生率（7.69%）低于对照组（22.92%），髋关节功能恢复优良率（94.23%）高于对照组（79.17%）（P＜0.05）。结论 基于ERAS理念的围术期医疗优化策略可在不增加手术难度的前提下，减轻术后疼痛、加速康复、降低并发症并改善髋关节功能，值得临床推广。

Abstract

Objective To investigate the clinical value of a perioperative medical optimization strategy based on the Enhanced Recovery After Surgery (ERAS) concept in the minimally invasive treatment of intertrochanteric femoral fractures in elderly patients using proximal femoral nail antirotation (PFNA).
Methods A retrospective study was conducted on 100 elderly patients (aged ≥80 years) with intertrochanteric femoral fractures who underwent PFNA minimally invasive treatment. According to the perioperative management protocol, they were divided into a control group (n=48, conventional treatment) and an observation group (n=52, ERAS-based optimization strategy). Surgical indicators, postoperative rehabilitation, complications, and clinical outcomes were compared between the two groups.
Results There were no statistically significant differences in operative time or intraoperative blood loss between the two groups (P>0.05). The time to first postoperative ambulation and length of hospital stay in the observation group were significantly shorter than those in the control group, and the Visual Analogue Scale (VAS) scores at 24h, 48h, and 72h postoperatively were significantly lower than those in the control group (P<0.05). The total incidence of complications in the observation group (7.69%) was lower than that in the control group (22.92%), and the excellent-good rate of hip joint function recovery (94.23%) was higher than that in the control group (79.17%) (P<0.05).
Conclusion   The perioperative medical optimization strategy based on the ERAS concept can reduce postoperative pain, accelerate rehabilitation, lower complication rates, and improve hip joint function without increasing surgical difficulty, thus meriting clinical promotion.