跟骨骨折外側延長L形切口并發癥非手術相關危險因素分析_《中國修復重建外科雜志》

作者：

郝東升 ¹ , 陳晨 ¹ , 王東 ² , 尹蕓生 ²

1山西醫學科學院山西大醫院骨科（太原，030009）;;
2山西醫科大學第二醫院骨科;

關鍵詞：

跟骨骨折切口并發癥危險因素

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目的探討采用外側延長L形切口行跟骨骨折切開復位內固定術后切口并發癥的非手術相關危險因素。方法回顧分析2006年9月－2011年8月58例63足經外側延長L形切口行切開復位內固定的閉合性跟骨骨折患者臨床資料。男52例56足，女6例7足；年齡18～64歲，平均35歲。致傷原因：墜落傷53例58足，交通事故傷5 例5足。傷后至手術時間3～22 d，平均8 d。骨折根據Sanders分型標準分型：Ⅱ型4足，Ⅲ型31足，Ⅳ型28足。觀察術后切口并發癥發生情況并分級，其中分級≥2級列入并發癥組， lt; 2級列入對照組。對可能導致切口并發癥的18個變量進行單因素分析，對差異有統計學意義的變量進行多因素非條件logistic回歸分析。結果41例46足切口Ⅰ期愈合，納入對照組；17例17足出現2級及以上切口并發癥，納入并發癥組。其中皮膚壞死、紅腫或裂開14例，淺表感染3例，均經對癥處理后愈合。單因素分析顯示，脊柱骨折、糖尿病及吸煙史3個變量差異有統計學意義（P lt; 0.05）；多因素分析顯示，脊柱骨折為獨立危險因素（95%可信區間：0.004～0.360，P=0.004）。結論合并脊柱骨折是采用外側延長L形切口行跟骨骨折切開復位內固定術后發生切口并發癥的獨立危險因素。

引用本文： 郝東升,陳晨,王東,尹蕓生. 跟骨骨折外側延長L形切口并發癥非手術相關危險因素分析. 中國修復重建外科雜志, 2013, 27(1): 30-35. doi: 復制

1.	Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17(4): 241-249.
2.	Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORlF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11): 868-873.
3.	Koski A, Kuokkanen H, Tukiainen E. Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures. Scand J Surg, 2005, 94(3): 243-245.
4.	Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
5.	郝東升, 尹蕓生, 李棟, 等. 螺旋CT三維重建在跟骨骨折手術治療中的價值. 中國現代醫學雜志, 2006, 16(23): 3611-3614.
6.	Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2): 225-250.
7.	Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res, 2001, (391): 7-16.
8.	Makki D, Alnajjar HM, Walkay S, et al. Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg (Br), 2010, 92(5): 693-700.
9.	Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma, 1999, 13(5): 369-372.
10.	Jorgensen LN, Kallehave F, Christensen E, et al. Less collagen production in smokers. Surgery, 1998, 123(4): 450-455.
11.	Thomsen T, Tønnesen H, Møller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg, 2009, 96(5): 451-461.
12.	Møller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet, 2002, 359(9301): 114-117.
13.	Court-Brown CM, Schmied M, Schutte BG. Factors affecting infection after calcaneal fracture fixation. Injury, 2009, 40(12): 1313-1315.
14.	Wukich DK, Lowery NJ, McMillen RL, et al. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Joint Surg (Am), 2010, 92(2): 287-295.
15.	Currie CJ, Peters JR, Tynan A, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet, 2010, 375(9713): 481-489.
16.	Sabanayagam C, Liew G, Tai ES, et al. Relationship between glycated haemoglobin and microvascular complications: is there a natural cut-off point for the diagnosis of diabetes? Diabetologia, 2009, 52(7): 1279-1289.
17.	龔振華, 姚建, 季建峰, 等. 負壓封閉引流技術治療軟組織損傷合并感染創面. 中華創傷雜志, 2012, 28(1): 76-77.
18.	李楠, 萬春友, 崔猛, 等. 改良封閉式負壓引流技術在骨科創面治療中的應用. 中國修復重建外科雜志, 2012, 26(1): 125-126.
19.	Stannard JP, Volgas DA, McGwin G 3rd, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma, 2012, 26(1): 37-42.
20.	劉新成, 陳雁西, 俞光榮. 手術治療跟骨骨折并發癥的Meta分析. 中華創傷雜志, 2010, 26(2): 109-113.

1. Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17(4): 241-249.
2. Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORlF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11): 868-873.
3. Koski A, Kuokkanen H, Tukiainen E. Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures. Scand J Surg, 2005, 94(3): 243-245.
4. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
5. 郝東升, 尹蕓生, 李棟, 等. 螺旋CT三維重建在跟骨骨折手術治療中的價值. 中國現代醫學雜志, 2006, 16(23): 3611-3614.
6. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2): 225-250.
7. Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res, 2001, (391): 7-16.
8. Makki D, Alnajjar HM, Walkay S, et al. Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg (Br), 2010, 92(5): 693-700.
9. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma, 1999, 13(5): 369-372.
10. Jorgensen LN, Kallehave F, Christensen E, et al. Less collagen production in smokers. Surgery, 1998, 123(4): 450-455.
11. Thomsen T, Tønnesen H, Møller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg, 2009, 96(5): 451-461.
12. Møller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet, 2002, 359(9301): 114-117.
13. Court-Brown CM, Schmied M, Schutte BG. Factors affecting infection after calcaneal fracture fixation. Injury, 2009, 40(12): 1313-1315.
14. Wukich DK, Lowery NJ, McMillen RL, et al. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Joint Surg (Am), 2010, 92(2): 287-295.
15. Currie CJ, Peters JR, Tynan A, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet, 2010, 375(9713): 481-489.
16. Sabanayagam C, Liew G, Tai ES, et al. Relationship between glycated haemoglobin and microvascular complications: is there a natural cut-off point for the diagnosis of diabetes? Diabetologia, 2009, 52(7): 1279-1289.
17. 龔振華, 姚建, 季建峰, 等. 負壓封閉引流技術治療軟組織損傷合并感染創面. 中華創傷雜志, 2012, 28(1): 76-77.
18. 李楠, 萬春友, 崔猛, 等. 改良封閉式負壓引流技術在骨科創面治療中的應用. 中國修復重建外科雜志, 2012, 26(1): 125-126.
19. Stannard JP, Volgas DA, McGwin G 3rd, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma, 2012, 26(1): 37-42.
20. 劉新成, 陳雁西, 俞光榮. 手術治療跟骨骨折并發癥的Meta分析. 中華創傷雜志, 2010, 26(2): 109-113.

《中國修復重建外科雜志》

跟骨骨折外側延長L形切口并發癥非手術相關危險因素分析

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《中國修復重建外科雜志》

跟骨骨折外側延長L形切口并發癥非手術相關危險因素分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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