可吸收线皮下隐性减张缝合切口的临床观察  

CLINICAL OBSERVATION OF HIDDEN TENSION SUTURE WITH ABSORBABLE THREAD

作　　者：彭建强[1] 胡明山[1] 周经颖[1] 林昆[1] 黄爱军[1] 

机构地区：[1]广东医学院附属福田医院骨科,广东深圳518033

出　　处：《中国修复重建外科杂志》2010年第3期319-321,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结可吸收线皮下隐性减张缝合胫腓骨骨折切开复位内固定术后切口的效果。方法2003年10月-2008年10月,对203例220侧胫腓骨骨折患者切开复位内固定术后切口分别使用可吸收线皮下隐性减张缝合(试验组,102例112侧)及普通间断缝合(对照组,101例108侧)。男179例,女24例;年龄3～75岁,中位年龄36岁。交通伤170例,重物砸伤21例,高处坠落伤12例。单侧186例,双侧17例。闭合骨折127侧;开放骨折93侧,按Gustilo分型:Ⅰ型38侧,Ⅱ型45侧,ⅢA型10侧。骨折部位:胫骨上段55侧,中段126侧,下段39侧。X线片示横形骨折65侧,斜形骨折53侧,螺旋形骨折45侧,粉粹性骨折57侧。骨折肢体无血管、神经损伤,无骨筋膜室综合征和挤压综合征等。受伤至手术时间2h～7d,平均2d。220侧骨折中45侧采用髓内钉内固定,其余均采用钢板螺钉内固定。结果对照组术后切口70例(69.3%)Ⅰ期愈合;31例(30.7%)Ⅱ期愈合,经重新清创换药或植皮后愈合。试验组93例(91.2%)Ⅰ期愈合;9例(8.8%)Ⅱ期愈合,经换药后愈合。两组术后切口Ⅰ期愈合率差异有统计学意义(P<0.05)。患者均获随访,随访时间6个月～2年,平均9个月。试验组Ⅰ期愈合患者无切口并发症,切口瘢痕较小;3例Ⅱ期愈合患者瘢痕增宽。对照组Ⅰ期愈合患者切口瘢痕较试验组明显,有蜈蚣样瘢痕;Ⅱ期愈合患者瘢痕均较明显。结论可吸收线皮下隐性减张缝合解决了胫腓骨骨折切开复位内固定术后切口皮肤张力大、难以缝合的问题,降低了术后发生皮肤坏死及需要游离植皮或皮瓣移位修复的可能,有利于术后切口愈合。Abstract： Objective To observe the operative technique and cl inical effects of hidden tension suture after tibiofibular fracture fixation with absorbable thread. Methods From October 2003 to October 2008, 203 patients （220 sides） with tibiofibular fracture underwent hidden tension suture （test group, 102 cases of 112 sides） and the common interrupted suture （control group, 101 cases of 108 sides）, including 179 males and 24 females with an median age of 36 years （3-75 years）. Fracture was caused by traffic accident in 170 cases, by heavy bruise in 21 cases, and by fall ing from height in 12 cases. There were 186 cases of single-side fracture, and 17 cases of double-side fracture. Of them, 127 sides were closed fracture, and 93 sides were open fracture （including 38 sides of type I, 45 sides of type II, and 10 sides of type IIIA according to Gustilo classification for the open fracture）. The locations were upper tibia in 55 sides, middle tibia in 126 sides, and lower tibia in 39 sides. The X-ray films showed that there were transverse fractures in 65 sides, obl ique fractures in 53 sides, spiral fractures in 45 sides, and comminuted fractures in 57 sides. No blood vessel injury, osteofascial compartment syndrome and pressure syndrome were observed. The time from injury to operation was 2 hours to 7 days with an average of 2 days. Of 220 sides, 45 sides were fixed by interlocking nails, others by internal steel plate. Results In control group, heal ing by first intention was achieved in 70 cases （69.3%） and heal ing by secondary intention in 31 cases （30.7%）; in test group, heal ing by first intention was achieved in 93 cases （91.2%） and heal ing by secondary intention in 9 cases （8.8%）; and showing significant difference （P 〈 0.05）. All patients were followed up for 6 months to 2 years （average 9 months）. No compl ication occurred in test group, and scar was obvious in the control group. Conclusion The hidden tension suture with absorbable thread can be a good alte

关 键 词：切口愈合 隐性减张缝合 可吸收线 

分 类 号：R687.3[医药卫生—骨科学]