上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

扩大L型切口治疗闭合性跟骨骨折伤口并发症的相关因素分析

伍 凯，林 健，黄建华，王秋根   

  1. 上海交通大学附属第一人民医院创伤骨科  上海市急救创伤中心， 上海 201620
  • 出版日期:2014-07-28 发布日期:2014-08-11
  • 通讯作者: 黄建华, 电子信箱: jhua470@163.com。
  • 作者简介:伍 凯（1975—）， 男， 主治医师， 硕士; 电子信箱: kaiwu0122@163.com。

Analysis of related risk factors of incision complications after closed calcaneal fracture surgery via extensive L-shaped incision

WU Kai, LIN Jian, HUANG Jian-hua, WANG Qiu-gen   

  1. Department of Orthopedics Trauma, Shanghai Emergency Trauma Centre, the First People's Hospital, Shanghai Jiao Tong University, Shanghai 200620, China
  • Online:2014-07-28 Published:2014-08-11

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摘要：

目的 探讨采用外侧L型切口治疗闭合性跟骨骨折后切口并发症的相关危险因素，评价临床干预手段的有效性。方法 回顾性分析209例患者（239例跟骨骨折）的病例资料，对可能导致跟骨切口并发症的7个因素（手术时机、手术时间、植骨、牵开方式、引流、吸烟和抗生素）进行单因素分析，对有统计学意义的因素进行多因素Logistic回归分析。结果 239例跟骨骨折中，21例（8.8%）出现手术切口并发症，其中8例（3.3%）伤口裂开，5例（2.1%）血肿形成，7例（2.9%）皮缘坏死，1例（0.4%）骨髓炎。单因素分析结果显示：手术时机、手术时间、引流、牵开方式、植骨和吸烟6个因素与切口并发症相关。多因素Logistic回归分析结果显示：手术时机早于伤后7 d、手术时间>1.5 h、术后不引流、静态牵开方式以及吸烟都是跟骨切口并发症的危险因素；抗生素应用时间长短和植骨与否对切口并发症的发生无显著影响。结论 推迟手术至伤后7 d、缩短手术时间、术后引流、注意牵开皮瓣的方式和时间、禁止吸烟对于避免跟骨术后切口并发症的发生可能有益。

关键词: 跟骨, 骨折, 切口, 手术并发症

Abstract:

Objective To explore the risk factors relevant to incision complications after closed calcaneal fracture surgery via a lateral L-shaped incision and to evaluate the effectiveness of clinical intervention methods. Methods The medical records of 209 patients (239 calcaneal fractures) were retrospectively analyzed. The univariate analysis of seven factors (the timing of surgery, operative duration, bone grafting, skin distraction method, postoperative drainage, smoking, and antibiotic) that might cause complications of calcaneal incision was conducted. The multiple Logistic regression analysis was conducted for factors with statistical significance. Results Among 239 cases of calcaneal fracture, 21 (8.8%) involved surgical incision complications, including 8 (3.3%) of wound dehiscence, 7 (2.9%) of flap margin necrosis, 5 (2.1%) of hematoma, and 1 (0.4%) of osteomyelitis. The results of univariate analysis showed that six factors were relevant to surgical incision complications, i.e. the timing of surgery, operative duration, postoperative drainage, skin distraction method, bone grafting, and smoking. The results of multiple Logistic regression analysis showed that surgeries performed within seven days after fracture, operative time >1.5 h, no drainage after surgery, static skin distraction, and smoking were risk factors of calcaneal incision complications. The duration of antibiotic administration and bone grafting had no significant effect on incision complications. Conclusion It is helpful for avoiding complications after calcaneal surgeries by postponing the surgery at least 7 d after fracture, shortening the surgery time, performing postoperative drainage, retracting skin flaps gently and shortly, and prohibiting smoking.

Key words: calcaneus, fracture, incision, surgical complication