• 1山西醫(yī)學(xué)科學(xué)院山西大醫(yī)院骨科（太原，030009）;;
  • 2山西醫(yī)科大學(xué)第二醫(yī)院骨科;

目的 探討采用外側(cè)延長L形切口行跟骨骨折切開復(fù)位內(nèi)固定術(shù)后切口并發(fā)癥的非手術(shù)相關(guān)危險(xiǎn)因素。 方法 回顧分析2006年9月－2011年8月58例63足經(jīng)外側(cè)延長L形切口行切開復(fù)位內(nèi)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(shù)時(shí)間3～22 d，平均8 d。骨折根據(jù)Sanders分型標(biāo)準(zhǔn)分型：Ⅱ型4足，Ⅲ型31足，Ⅳ型28足。觀察術(shù)后切口并發(fā)癥發(fā)生情況并分級，其中分級≥2級列入并發(fā)癥組， lt; 2級列入對照組。對可能導(dǎo)致切口并發(fā)癥的18個(gè)變量進(jìn)行單因素分析，對差異有統(tǒng)計(jì)學(xué)意義的變量進(jìn)行多因素非條件logistic回歸分析。 結(jié)果41例46足切口Ⅰ期愈合，納入對照組；17例17足出現(xiàn)2級及以上切口并發(fā)癥，納入并發(fā)癥組。其中皮膚壞死、紅腫或裂開14例，淺表感染3例，均經(jīng)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(gè)變量差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）；多因素分析顯示，脊柱骨折為獨(dú)立危險(xiǎn)因素（95%可信區(qū)間：0.004～0.360，P=0.004）。 結(jié)論合并脊柱骨折是采用外側(cè)延長L形切口行跟骨骨折切開復(fù)位內(nèi)固定術(shù)后發(fā)生切口并發(fā)癥的獨(dú)立危險(xiǎn)因素。

引用本文： 郝東升,陳晨,王東,尹蕓生. 跟骨骨折外側(cè)延長L形切口并發(fā)癥非手術(shù)相關(guān)危險(xiǎn)因素分析. 中國修復(fù)重建外科雜志, 2013, 27(1): 30-35. doi: 復(fù)制

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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(shù)治療中的價(jià)值. 中國現(xiàn)代醫(yī)學(xué)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(fù)壓封閉引流技術(shù)治療軟組織損傷合并感染創(chuàng)面. 中華創(chuàng)傷雜志, 2012, 28(1): 76-77.
18. 李楠, 萬春友, 崔猛, 等. 改良封閉式負(fù)壓引流技術(shù)在骨科創(chuàng)面治療中的應(yīng)用. 中國修復(fù)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(shù)治療跟骨骨折并發(fā)癥的Meta分析. 中華創(chuàng)傷雜志, 2010, 26(2): 109-113.
  1. 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. 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. 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. 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. 5. 郝東升, 尹蕓生, 李棟, 等. 螺旋CT三維重建在跟骨骨折手術(shù)治療中的價(jià)值. 中國現(xiàn)代醫(yī)學(xué)雜志, 2006, 16(23): 3611-3614.
  6. 6. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2): 225-250.
  7. 7. Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res, 2001, (391): 7-16.
  8. 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. 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. 10. Jorgensen LN, Kallehave F, Christensen E, et al. Less collagen production in smokers. Surgery, 1998, 123(4): 450-455.
  11. 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. 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. 13. Court-Brown CM, Schmied M, Schutte BG. Factors affecting infection after calcaneal fracture fixation. Injury, 2009, 40(12): 1313-1315.
  14. 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. 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. 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. 17. 龔振華, 姚建, 季建峰, 等. 負(fù)壓封閉引流技術(shù)治療軟組織損傷合并感染創(chuàng)面. 中華創(chuàng)傷雜志, 2012, 28(1): 76-77.
  18. 18. 李楠, 萬春友, 崔猛, 等. 改良封閉式負(fù)壓引流技術(shù)在骨科創(chuàng)面治療中的應(yīng)用. 中國修復(fù)重建外科雜志, 2012, 26(1): 125-126.
  19. 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. 20. 劉新成, 陳雁西, 俞光榮. 手術(shù)治療跟骨骨折并發(fā)癥的Meta分析. 中華創(chuàng)傷雜志, 2010, 26(2): 109-113.