Application of enhanced recovery after surgery in treating Gustilo type Ⅰ&Ⅱ open distal humeral fractures / 国际外科学杂志

ABSTRACT

Objective To compare the function outcome and complication of emergency operation and staged operation with enhanced recovery after surgery (ERAS) for Gustilo type Ⅰ &Ⅱ open distal humeral fractures.Methods Retrospective analysis of 22 patients with Gustilo type Ⅰ & Ⅱ open distal humeral fractures who were treated in Department of Orthopeaedic Trauma,Beijing Jishuitan Hospital from July 2013 to June 2017 was conducted.There were 18 males and 4 females,aged (42.5± 13.0) years,with an age range of 14-65 years.According to different treatment methods,all patients were divided into two groupsemergency operation group (n =6),direct internal fixation after emergency debridement;staged operation group (n =16),emergency debridement and suture,performed the second period of fixed treatment after the soft tissue condition to improve.Patient's waiting time from emergency to surgery,fasting time,surgery time,intra-op blood loss,hospital stay time,elbow range of motion,Mayo elbow performance score (MEPS),secondary surgery rate and complication at the last outpatient visit at 1,3,6,12 and June 2018,post-operatively were recorded.The measurement data of normal distribution and homogeneity of variance were expressed as mean ± standard deviation (Mean ± SD),and the independent sample t test was used for comparison between the two groups;the measurement data not conforming to the normal distribution were expressed as [M(P25,P75)].The rank sum test was used for comparison between the two groups.Comparison of count data between the two groups was performed by x2 test or Fisher exact probability method.Results The time from emergency to surgery of emergency group and staged group was [5.1(4.5,7.3) h],[160.0(102.9,221.2) h],respectively,P ＜0.001.Fasting time was [5.1(4.5,7.3) h],[12.1(9.7,13.2)h],P＜0.001.Hospital stay time was [5.5(5.0,6.5) d],[11.5(9.0,13.0) d],P=0.001.These differences were significant.Surgery time was [3.0 (2.0,3.6) h,2.6 (2.0,3.4) h].Intra-op blood loss was [75.0(25.0,225.0)ml,100.0(100.0,200.0)ml].Elbow range of motion was [155.0(141.3,155.0)°,155.0 (143.8,155.0) °].MEPS was [95.0 (83.8,100.0) scores,90.0 (80.0,100.0) scores].Secondary surgery rate was(33.3％ vs.31.2％).Complication rate was (83.3％ vs.68.7％).These differences were not significant (P ＞0.05).Conclusions ERAS's quick emergency surgery for Gustilo type Ⅰ&Ⅱ open distal humeral fractures significantly reduces the waiting time from emergency to surgery,fasting time and hospital stay time.Function outcome is comparable to the staged group.Therefore,emergency surgical procedures are recommended for patients with Gustilo typeⅠ&Ⅱ open distal humeral fractures.