关键词: 加速康复外科, 三角纤维软骨复合体损伤, 预康复, 早期康复, 腕关节镜

Abstract: Objective To observe the perioperative efficacy of the comprehensive treatment of enhanced recovery after surgery(ERAS)in patients with triangular fibrocartilage complex(TFCC)injury after undergoing transcarpal arthroscopic repair. Methods A retrospective collection was carried out on 46 patients with TFCC injuries who underwent transcarpal arthroscopic repair in Qilu Hospital of Shandong University from January to December 2023. The patients who underwent ERAS comprehensive rehabilitation were assigned to the observation group, and those who received conventional rehabilitation were designated as the control group, with 23 cases in each group. Both the observation group and the control group were treated with the same modality of external orthotic fixation postoperatively. In the initial three-week period, an above-elbow orthosis was applied. Subsequently, at the three-week mark, a review was conducted and, based on the assessment, the forearm external fixation orthosis was substituted. After six weeks, in accordance with the reevaluation findings, the external fixation orthosis was removed and a progressive resumption of rehabilitation training was initiated. Among them, the control group carried out rehabilitation exercises on their own according to the preoperative conversation and the doctors advice during the review. In the observation group, pre-rehabilitation exercises, nutritional support, and psychological counseling were initiated prior to surgery, followed by a comprehensive evaluation. Subsequently, a comprehensive assessment was conducted to develop an individualized comprehensive nursing plan for the patients. After the operation, an early progressive rehabilitation treatment was adopted, which comprised muscle training, joint mobilization, physiotherapy, and activities of daily living training. The entire process was supervised and directed by nursing staff until completion. The visual analogue scale(VAS)for pain was scored at 6 and 12 weeks postoperatively, and the range of joint motion and the modified MAYO wrist score were evaluated at 12 weeks after the operation. Results The pain VAS scores of the observation group at 6 and 12 weeks after surgery were both lower than those of the control group. At 12 weeks after surgery, the wrist joint dorsiflexion, palmar flexion, radial deviation, ulnar deviation range of motion and MAYO wrist score of the observation group were all higher than those of the control group, and the differences were statistically significant(P<0.05). Conclusion The application of the ERAS concept in patients with TFCC injuries can shorten the rehabilitation treatment time, enhance the rehabilitation effect, strengthen the curative effect of the surgery, and help patients return to social life as soon as possible.

Key words: Enhanced recovery after surgery, Triangular fibrocartilage complex injury, Prehabilitation, Early rehabilitation, Wrist arthroscopy