跟骨关节内骨折锁定钢板固定后高压氧辅助治疗的临床效果  

Clinical efficacy of hyperbaric oxygen therapy combined with locking plate for intra-articular calcaneal fractures

作　　者：许运[1] 史勇[1] 欧阳林志[1] 陶卫建[1] 简争光 孙雪峰[1] 马春艳[1] 唐天驷[2] 

机构地区：[1]苏州市相城人民医院骨科,江苏省苏州市215131 [2]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2014年第48期7816-7821,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:切口感染、皮缘坏死、局部皮肤缺损、骨髓炎等是跟骨扩大外侧手术入路常见并发症,处理困难。高压氧治疗在严重挤压伤、慢性骨髓炎、慢性皮肤缺损溃疡等骨科疾病领域中有较为广泛的应用,运用高压氧治疗可能是跟骨骨折固定后切口并发症是一种有效方法。目的:探索高压氧辅助治疗对跟骨关节内骨折手固定后临床疗效的影响。方法:收集2010年1月至2012年9月收治的采用扩大外侧入路切开复位内固定治疗跟骨关节内骨折80例患者,根据患者治疗方法的不同分为高压氧治疗组和对照组,各40例,高压氧治疗组患者在固定后24 h后开始接受高压氧治疗,而对照组患者接受的是高压空气。结果与结论:高压氧治疗组3例,对照组4例由于不能耐受高压氧治疗而退出,其余73例患者至少获得2年以上的完整随访。两组患者人口学统计学情况差异无显著性意义(P>0.05)。高压氧治疗组有1例(3%)浅表感染,对照组固定后切口感染3例(8%);高压氧治疗组总的并发症4例(11%),对照组12例(33%),差异有显著性意义(P=0.020)。固定后6个月两组患者美国足踝外科协会评分、SF-36评分、目测类比评分,差异有显著性意义(P<0.05),但固定后2年后两组患者上述指标的差异无显著性意义(P>0.05)。提示高压氧辅助治疗可以预防并降低跟骨骨折经扩大外侧入路手固定后切口并发症的发生比率,高压氧治疗能够明显提高跟骨骨折固定后近期的临床疗效,但对随访2年后的临床效果改善不明显。BACKGROUND： Wound infection, skin flap necrosis, local skin defects, and osteomyelitis are common complications following extensile lateral approach for calcaneal fracture, and these complications are very intractable. Hyperbaric oxygen therapy has been widely applied in treatment of severe crush injury, chronic osteomyelitis, chronic skin ulcers and defects, and other orthopedic diseases. Hyperbaric oxygen therapy may be a potential means to treat wound complications after calcaneal fracture fixation. OBJECTIVE： To assess the effectiveness of hyperbaric oxygen therapy in displaced intra-articular fractures after open reduction and internal fixation through an extensile lateral approach. METHODS： From January 2010 to September 2012, 80 patients with intra-articular calcaneal fractures after open reduction and internal fixation were randomized into two groups, receiving hyperbaric oxygen therapy （HBOT group） or hyperbaric air treatment （control group）. Each group contained 40 patients. RESULTS AND CONCLUSION： Three cases in HBOT group and four cases in control group were excluded due to intolerance to hyperbaric oxygen therapy, and the remaining 73 patients were followed and assessed for a minimum of two years of follow-up. The demographic data showed no significant difference between the two groups （P 〉 0.05）. The rates of infection were 3% （one case） in HBOT group and 8% （three cases） in control group. The overall complication rates for HBOT group and control group were 11% （four cases） and 33% （12 cases）, respectively （P = 0.020）. At 6 months after hyperbaric oxygen therapy, American Orthopaedic Foot and Ankle Society score, SF-36 score, VAS score were significantly better outcomes for HBOT group as compared with control group （P 〈 0.05）. However, these outcome measures did not differ significantly between the two groups after 2 years of follow-up （P 〉 0.05）. Adjunctive hyperbaric oxygen therapy would prevent and reduce the overall complication rate af

关 键 词：植入物 骨植入物 跟骨 骨折 切开复位内固定 并发症 高压氧治疗 临床效果 

分 类 号：R318[医药卫生—生物医学工程]