[1]陆义安,薛锋.跟骨骨折切开复位内固定术后切口愈合不良的危险因素分析[J].中医正骨,2018,30(04):43-45.
　LU Yian,XUE Feng.Analysis of risk factors for poor healing of incision after open reduction and internal fixation for treatment of calcaneus fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(04):43-45.
点击复制

跟骨骨折切开复位内固定术后切口愈合不良的危险因素分析()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年04期
页码:
43-45
栏目:
临床研究
出版日期:
2018-04-20

文章信息/Info

Title:
Analysis of risk factors for poor healing of incision after open reduction and internal fixation for treatment of calcaneus fractures
作者:
陆义安; 薛锋
上海市奉贤区中心医院,上海 201499
Author(s):
LU Yian; XUE Feng
Fengxian District Central Hospital,Shanghai 201499,China
关键词:
骨折固定术; 内;  跟骨骨折;  伤口愈合;  危险因素;  Logistic模型
Keywords:
Keywords fracture fixation; internal;  fracture of calcaneus;  wound healing;  risk factors;  Logistic models
摘要:
目的:分析跟骨骨折切开复位内固定术后切口愈合不良的危险因素。方法:选取91例(91足)采用切开复位内固定术治疗的闭合性跟骨骨折患者作为研究对象。男66例,女25例; 年龄22～80岁,中位数47岁; 高处坠落伤79例,车祸伤12例; 按照Sanders分型标准,Ⅱ型40例、Ⅲ型39例、Ⅳ型12例; 伤后至手术时间3 h至15 d,中位数9 d。收集患者的病例资料,提取年龄、性别、骨折类型、血清白蛋白水平、伤后至手术时间、是否进行人工骨植骨、手术时间、切口缝合方式、切口愈合情况等信息。先采用单因素分析对自变量进行筛选,再通过Logistic回归分析确定跟骨骨折切开复位内固定术后切口愈合不良的危险因素。结果:术后13例切口愈合不良(愈合不良组),其中8例患者出现切口皮缘坏死或裂开、5例发生切口浅表感染,其余78例患者切口愈合良好(愈合良好组)。愈合不良组和愈合良好组骨折类型、低白蛋白血症(血清白蛋白<35 g·L-1)、伤后至手术时间、手术时间、切口缝合方式比较,组间差异均有统计学意义(χ2=10.202,P=0.006; χ2=6.398,P=0.011; χ2=3.863,P=0.049; χ2=4.658,P=0.031; χ2=8.729,P=0.003)。以切口愈合情况为因变量,将单因素分析结果中有意义的5个因素纳入多因素Logistic回归分析,结果显示低白蛋白血症(OR=1.757,P=0.000)、伤后至手术时间<7 d(OR=3.324,P=0.015)、手术时间>90 min(OR=4.379,P=0.003)及切口褥式缝合(OR=1.254,P=0.004)是跟骨骨折切开复位内固定术后切口愈合不良的危险因素。结论:低白蛋白血症、伤后至手术时间<7 d、手术时间>90 min及切口褥式缝合是跟骨骨折切开复位内固定术后切口愈合不良的危险因素。
Abstract:
ABSTRACT Objective:To analyze the risk factors for poor healing of incision after open reduction and internal fixation for treatment of calcaneus fractures.Methods:Ninety-one patients(91 feet)with closed calcaneus fractures who had been treated with open reduction and internal fixation were selected as the subjects.The patients consisted of 66 males and 25 females,and ranged in age from 22 to 80 years(Median=47 yrs)and ranged in disease course from 3 hours to 15 days(Median=9 days).The fractures were caused by high falling injuries(79)and traffic accident injuries(12),and the fractures belonged to typesⅡ(40),Ⅲ(39)andⅣ(12)according to Sanders classification standard.The medical records of these patients were collected and the information about age,gender,fracture type,serum level of albumin,time from injury to surgery,artificial bone grafting,operative time,incision suturing method and incision healing were extracted for analysis.The independent variables were screened by using single-factor analysis and the risk factors for poor healing of incision after open reduction and internal fixation for treatment of calcaneus fractures were confirmed by using Logistic regression analysis.Results:The postoperative poor-healed incisions were found in 13 patients(poor-healed group),including skin necrosis or rupture at the incision margin(8)and superficial incision infection(5),and incisions healed well in the other patients(well-healed group).There was statistical difference in fracture type,hypoalbuminemia(serum albumin<35 g/L),time from injury to surgery,operative time and incision suturing method between poor-healed group and well-healed group(χ2=10.202,P=0.006; χ2=6.398,P=0.011; χ2=3.863,P=0.049; χ2=4.658,P=0.031; χ2=8.729,P=0.003).The incision healing was chosen as the dependent variable and the five significative factors chosen from the results of single-factor analysis were included in multiple-factor Logistic regression analysis.Finally the results demonstrated that hypoalbuminemia(OR=1.757,P=0.000),time from injury to surgery of<7 days(OR=3.324,P=0.015),operative time of>90 minutes-------------------(OR=4.379,P=0.003)and incision mattress-suture(OR=1.254,P=0.004)were the risk factors for postoperative poor healing of incision following open reduction and internal fixation for treatment of calcaneus fractures.Conclusion:Hypoalbuminemia,time from injury to surgery of<7 days,operative time of>90 minutes and incision mattress-suture are the risk factors for postoperative poor healing of incision following open reduction and internal fixation for treatment of calcaneus fractures.

参考文献/References:

[1] 彭雄,邱波.跟骨外侧U形切口结合解剖钢板内固定治疗SandersⅢ、Ⅳ型跟骨骨折疗效探讨[J].生物骨科材料与临床研究,2016,13(4):25-27.
[2] 吴群生.切开复位可塑性钛板内固定联合自体髂骨植骨治疗跟骨关节内骨折[J].中医正骨,2017,29(2):57-59.
[3] 陈志军,朱东波,王树金,等.跗骨窦切口钢板螺钉治疗SandersⅡ、Ⅲ型跟骨骨折[J].临床骨科杂志,2017,20(2):220.
[4] 沙良宽,田家祥,李敬祥,等.撬拨复位与切开复位内固定治疗Sanders Ⅱ型跟骨骨折的比较[J].中国修复重建外科杂志,2015,29(5):558-562.
[5] 姚琦,仇永辉,祝孟海,等.跟骨骨折术后切口并发症的分析及预防策略[J].中华创伤骨科杂志,2015,17(9):757-760.
[6] 董新利,苏云,孙强,等.改良间断垂直褥式缝合方法在关闭跟骨骨折切口中的应用[J].实用骨科杂志,2017,23(2):185-187.
[7] SINDGIKAR V,NARASANAGI B,TEJASVINI V,et al.Effect of serum albumin in wound healing and its relatedcomplications in surgical patients[J].AI Ameen J Med Sci,2017,10(2):132-135.
[8] SANDERS R.Displaced intra-articular fractures of the calcaneus[J].J Bone Joint Surg Am,2000,82(2):225-250.
[9] TALUKDAR M,GOPALARATHNAM S,PAUL R,et al.Clinical study on factors influencing wound dehiscence in emergency exploratory laparotomy[J].J Evolution Med Dent Sci,2016,5(34):1934-1938.
[10] AIGNER R,SALOMIA C,LECHLER P,et al.Relationship of prolonged operative time and comorbidities with complications after geriatric ankle fractures[J].Foot Ankle Int,2017,38(1):41-48.

相似文献/References:

[1]温超海,何忠,李永斌,等.闭合复位伽玛钉改良成锁定支架内固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(11):32.
[2]肖善富,张喜善,于凤珍.髌下小切口钢丝纽扣式内固定治疗胫骨髁间隆突骨折[J].中医正骨,2015,27(11):34.
[3]朱峰,宋相建,吴蔚,等.手法复位经皮克氏针内固定治疗 儿童闭合性肱骨远端全骨骺分离[J].中医正骨,2015,27(11):51.
[4]袁伟,周晓莉.T形掌指骨微型钢板内固定治疗锁骨近端骨折[J].中医正骨,2015,27(10):47.
[5]唐剑邦,吴宇峰,高大伟,等.切开复位肱骨近端锁定钢板内固定治疗 陈旧性肩关节后脱位合并肱骨近端骨折[J].中医正骨,2015,27(10):49.
[6]刘磊,万春友,全先辉,等.锁定钢板内固定结合肱骨头植骨重建治疗 肱骨近端Neer三、四部分骨折[J].中医正骨,2015,27(10):52.
[7]白晨平.微型自攻空心螺钉内固定治疗掌指骨关节内骨折[J].中医正骨,2015,27(09):34.
[8]钱平康,徐锋,孙斌峰,等.肱骨近端内锁定系统固定结合植骨治疗肱骨近端骨折[J].中医正骨,2015,27(09):36.
[9]陈红卫,王子阳,李军,等.肘关节后外侧入路联合前内侧入路治疗 肘关节恐怖三联征[J].中医正骨,2015,27(09):40.
[10]邢金明.切开复位锁定钢板内固定术和人工半肩关节置换术 治疗老年肱骨近端复杂骨折的对比研究[J].中医正骨,2015,27(08):11.
　XING Jinming.A retrospective trial of open reduction and locking plate internal fixation versus artificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):11.
[11]王俊义,王巧迪.布巾钳钳夹复位经皮克氏针内固定术治疗儿童和青少年闭合性锁骨骨折[J].中医正骨,2017,29(08):76.
[12]彭林,童培建.切开复位内固定结合带骨膜髂骨板移植治疗合并胫骨远端关节面缺损的Pilon骨折[J].中医正骨,2018,30(07):64.
[13]程省,汤立新,赵玉果,等.切开复位空心钉内固定与闭合复位经皮克氏针内固定治疗GeddaⅠ型Bennett骨折的比较研究[J].中医正骨,2021,33(09):20.
　CHENG Sheng,TANG Lixin,ZHAO Yuguo,et al.A comparative study of open reduction and hollow screws internal fixation versus closed reduction and percutaneous Kirschner wires internal fixation for treatment of Gedda typeⅠBennett fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(04):20.

备注/Memo

备注/Memo:
通讯作者:薛锋 E-mail:xuefengmd@sina.com
更新日期/Last Update: 2018-08-24