Application of enhance recovery after surgery combined with system nursing in patients with thoracolumbar fracture accompanied by nerve injury / 中华创伤杂志

ABSTRACT

Objective:To discuss the application effect of enhance recovery after surgery (ERAS) combined with system nursing in patients with thoracolumbar fracture accompanied by nerve injury.Methods:A retrospective case-control study was conducted to analyze the clinical data of 84 patients with bilateral thoracolumbar fractures accompanied by nerve injury admitted to Henan Provincial People's Hospital from August 2017 to January 2020. All patients were treated with posterior thoracolumbar spinal canal decompression, bone grafting and internal fixation. There were 55 males and 29 females, aged 36-49 years [(43.2±5.2)years]. The injury segments were located at T 10-T 11 in 6 patients, T 11-T 12 in 38, T 12-L 1 in 31, and L 1-L 2 in 9. According to the Frankel classification of neurological function, 19 patients were rated as grade A, 22 grade B, 38 grade C, and 5 grade D. A total of 42 patients were treated by ERAS combined with system nursing (ERAS group), and 42 patients by routine rehabilitation nursing (routine nursing group). The hospitalization time, incidence of perioperative complications, and patients' satisfaction with nursing work were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated at postoperative 1 week and 3 months. The Frankel classification of neurological function and the MOS item short from health survey (SF-36) score were measured at postoperative 3 months. Results:All patients were followed up for 3-4 months [(3.2±1.7)months]. The hospitalization time in ERAS group was (10.9±1.6)days, significantly shorter than (14.4±1.2)days in routine nursing group ( P<0.05). The incidence of perioperative complications in ERAS group was 10%(4/42), significantly shorter than 29%(12/42) in routine nursing group ( P<0.05). The satisfaction rates in ERAS group and routine nursing group were 93%(39/42) and 76%(32/42), respectively ( P<0.05). At 1 week and 3 months after operation, the VAS in ERAS group [(1.7±0.4)points, (1.2±0.3)points]was significantly lower than those in routine nursing group [(4.8±0.9)points, (3.1±0.7)points]( P<0.05). At 1 week and 3 months after operation, the ODI in ERAS group [(13.5±1.8)points, (10.3±1.4)points] was significantly lower than those in routine nursing group [(17.9±2.0)points, (15.6±2.1)points]( P<0.05). At 3 months after operation, according to the Frankel classification, there were 2 patients with grade A, 9 with grade B, 13 with grade C, 13 with grade D and 5 with grade E in ERAS group, and there were 8 patients with grade A, 8 with grade B, 12 with grade C, 10 with grade D, and 4 with grade E in routine nursing group. The recovery rate of grade A or above in ERAS group was 95%(40/42), significantly higher than 81%(34/42) in routine nursing group ( P<0.05)]. At 3 months after operation, the SF-36 score in ERAS group was better than that in routine nursing group ( P<0.05). Conclusion:For patients with thoracolumbar fracture accompanied by nerve injury, ERAS combined system nursing can shorten the hospitalization time, reduce perioperative complications, improve patients' satisfaction, reduce pain, promote the recovery of nerve function, and improve the quality of life.