Application Of ERAS In The Treatment Of Intertrochanteric Fracture Of Femur In The Elderly

Objective To apply the concept of Enhanced recovery after surgery（ERAS）to the diagnosis and treatment of senile intertrochanteric fractures,and to explore the perioperative effects of enhanced recovery after surgery for senile intertrochanteric fractures.Methods Clinical data of elderly patients with intertrochanteric fracture of femur admitted to our hospital from September 2019 to August 2021 were collected.Patients with intertrochanteric fracture of the femur from September 2019 to August 2020（29 cases）received routine treatment as the conventional group,while patients with intertrochanteric fracture of the femur from September 2020 to August 2021（28 cases）received ERAS concept intervention as the ERAS group.Preoperative waiting time,operation time,amount of blood loss,length of stay,hospitalization cost,incidence of postoperative complications,serum AOPP,MDA,SOD and other oxidative stress indicators were recorded.Bone metabolism indexes including t PINP,β-CTX and OC were recorded before and 1week after operation,and Harris score of hip function was recorded 2 weeks,1month and 3 months after operation.SPSS22.0 statistical software was used for data analysis.Result（1）In the general data of the two groups,gender（ERAS group: 9males and 19 females,conventional group: 10 males and 19 females）,age（ERAS group: 78.68 ± 7.30 years,conventional group: 79.24 ± 6.24 years）,distribution of affected limbs（ERAS group:15 cases on the left,13 cases on the right,conventional group:13 cases on the left and 16 cases on the right）,there was no significant difference between the two groups（P > 0.05）.（2）The waiting time before operation,operation time,blood loss,hospitalization days,hospitalization expenses and the incidence of postoperative complications in ERAS group were all lower than those in conventional group,and the differences were statistically significant（P < 0.05）.（3）There was no significant difference in preoperative AOPP,SOD,MDA,t PINP,β-CTX,OC between ERAS group and conventional group（P > 0.05）;The postoperative AOPP（27.25 ± 1.48μmol/L）,MDA（17.57 ± 1.23nmol/L）,andβ-CTX（712.82 ± 15.59pg/ml）in the ERAS group were significantly higher than those in the routine group AOPP（32.03 ± 3.83μmol/L）,MDA（21.72 ± 1.98nmol/L）and β-CTX（748.72 ± 26.29pg/ml）,the differences were statistically significant（P <0.05）;postoperative SOD（385.39 ± 7.81U/L）,t PINP（51.89 ± 3.60ng/ml）,OC（23.93± 2.49ng/ml）in ERAS group were higher than those of conventional group SOD（339.28 ± 11.28U/L）,t PINP（44.07 ± 4.44ng/ml）,OC（20.48 ± 2.50ng/ml）,The difference was statistically significant（P < 0.05）;（4）Hip Harris score at 2 weeks,1month,and 3 months after operation,the ERAS group（59.75 ± 3.13,71.71 ± 3.64,91.18 ± 2.44）was higher than the conventional group（56.14 ± 3.64,67.90 ± 3.16,87.93 ± 2.94）,the difference was all were statistically significant（P < 0.05）;Conclusion The application of ERAS in the perioperative period of senile intertrochanteric fracture of femur can not only shorten the waiting time before operation,reduce the amount of blood loss,reduce the occurrence of complications,shorten the hospitalization time,reduce the hospitalization expenses,speed up the recovery of hip joint function,but also reduce the level of oxidative stress and regulate the level of bone metabolism.ERAS is of great significance in promoting the rehabilitation of elderly patients with intertrochanteric fracture of femur,and it is worthy of clinical promotion.