论文部分内容阅读
目的:探讨日间全髋关节置换术（total hip arthroplasty，THA）治疗髋关节骨关节病的安全性、经济学效应及短期临床疗效。方法:回顾性分析2020年7月至2021年7月接受48 h出院的日间初次THA手术的患者75例（日间组），根据年龄和性别按1∶1的比例匹配75例在相同时间段内接受常规初次THA的患者（常规组）。比较两组患者的性别、年龄、体质指数（body mass index，BMI）、诊断、居住地、住院时间、手术时间、术前及术后第1天血红蛋白、白蛋白、C反应蛋白（C reactive protein，CRP）、D-二聚体、术后第2天视觉模拟评分（visual analogue scale，VAS）、术前及术后1个月髋关节改良Harris评分、术后1个月再入院及再手术情况。结果:两组患者年龄、性别、BMI、诊断、术前髋关节改良Harris评分的差异无统计学意义（n P>0.05）；日间组患者均来自于浙江省内且杭州市内比例高（48%，36/75），常规组有6例患者来自外地，两组患者居住地的差异有统计学意义（χn 2=6.29，n P=0.043）。日间组住院时间为（2.13±0.52）d，较常规组的（6.71±1.44）d缩短（n t=25.91，n P<0.001）；手术时间为（59.73±18.91）min，较常规组的（66.91±22.40）min缩短（n t=2.12，n P=0.036）；平均住院费用为（4.60±0.44）万元，较常规组的（5.20±0.72）万元较少（n t=6.16，n P0.05), but a significant difference was found in term of residence (χn 2=6.29, n P=0.043), that the patients in the outpatient group were all from Zhejiang Province and 48% (36/75) of them were from Hangzhou City. While, in the conventional group, 6 patients were from other provinces. The length of stay was 2.13±0.52 days and operation time was 59.73±18.91 minutes in the outpatient group, which were both shorter than those (6.71±1.44 days and 66.91±22.40 min) in the conventional group (n t=25.91, n P<0.001 for the length of hospital stay;n t=2.12, n P=0.036 for operation time). Compared with the conventional group, outpatient group saved the average hospital cost (4.60±0.44 n vs. 5.20±0.72 ten thousand yuan, n t=6.16, n P<0.001). The VAS on the second day after surgery 3.45±0.75 was higher in the outpatient group than in the conventional group (3.45±0.75n vs. 3.16±0.94 points, n t=2.09, n P=0.039). The modified Harris score was without statistical significance (n t=0.42, n P=0.677) 1 month after surgery in both groups. 75 patients in the outpatient group, 7 patients delayed discharge (were not discharge within 48 hours), and the rate of delayed discharge was 9.3%. Reasons for delayed discharge included poor pain control in two cases, one case had postoperative nausea and vomiting, one case had failed to meet rehabilitation standards, hypotension in one case, the intraoperative infection in one case and postoperative fever within 48 hours in one case.n Conclusion:Outpatient THA can reduce the length of hospital stay, operative time and total cost of hospitalization. It has similar safety and early clinical efficacy as conventional THA. However, a small proportion of patients would delay discharge.