跟骨骨折术后切口并发症的分析及预防策略  

Wound complications after operative fixation of calcaneal fracture

作　　者：姚琦[1] 仇永辉 祝孟海 倪杰[1] 彭立彬[1] 袁晓明[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院,100038

出　　处：《中华创伤骨科杂志》2015年第9期757-760,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨跟骨骨折切开复位内固定术后切口并发症发生的原因及预防策略. 方法 回顾性分析2008年1月至2013年12月治疗的65例跟骨骨折患者资料,男38例,女27例;年龄19 ～ 68岁,平均45岁;左侧29例,右侧36例;骨折按Sanders分型：Ⅱ型27例,Ⅲ型24例,Ⅳ型14例;受伤至手术时间3h至17d,平均6.2d;采用跟骨外侧入路,钢板内固定和植骨治疗,观察术后伤口并发症发生情况,根据住院期间是否发生切口并发症分为并发症组（9例,13.8％）和无并发症组（56例）,比较两组患者年龄、性别、骨折类型、美国麻醉医师协会评级、坠落高度、止血带使用时间及手术时间等手术相关因素,筛选导致跟骨骨折术后切口感染发生的危险因素. 结果 美国麻醉医师协会评级Ⅱ级及以上（OR=8.750,P=0.002）、坠落高度（OR=9.570,P=0.003）、止血带使用时间（P=0.020）、手术时间（P=0.025）、受伤至手术时间（P=0.004）、住院时间（P=0.013）、低白蛋白血症（OR=6.000,P=0.012）等与跟骨术后切口感染有重要联系. 结论 在常规诊疗措施的基础上,针对上述因素,重视术前软组织损伤评估、正确把握手术时机、缩短手术时间和止血带使用时间,及合理处理术后伤口是预防跟骨骨折术后发生切口并发症的有效方法.Objective To explore the causes and prevention strategies of wound complications after operative fixation of calcaneal fracture.Methods A retrospective analysis was performed of the 65 patients with calcaneal fracture who had been treated with operative fixation from January 2008 to January 2013 at our department.They were 38 males and 17 females,19 to 68 years of age （average,45 years）.Laterality：29 on the left side and 36 on the right side.According to Sanders classification,16 cases were type Ⅱ,35 type Ⅲ,and 14 type Ⅳ.The duration from injury to surgery ranged from 3 hours to 14 days,averaging 7.1 days.The fractures were treated by the extended lateral approach,internal fixation with plate and bone transplantation.Their postoperative wound complications were documented.Wound complications occurred in 9 cases （13.8%） but did not in the other 56 ones.The 2 groups were compared in terms of age,gender,fracture type,American Society of Anesthesiologists（ASA） grading,fall height,operation time,tourniquet time and other surgery-associated factors to screen out the risk factors associated with wound complications.Results We found that ASA grading Ⅱ or above （OR =8.750,P =0.002）,fall height （OR =9.570,P =0.003）,operation time （P=0.027）,tourniquet time （P-0.020）,fime from injury to operation（P=0.004）,hospital stay （P =0.013）,hypoproteinemia （OR =6.000,P =0.012） were significantly associated with wound complications.Conclusions On the basis of routine treatment,these risk factors should be targeted by prevention measures.The postoperative wound complications after operative fixation of calcaneal fracture can be effectively prevented by careful assessment of soft tissue defects,proper timing for surgery,shortening operation time and tourniquet time,and rational management of postoperative wounds.

关 键 词：跟骨 骨折 骨折固定术 内 手术后伤口感染 

分 类 号：R687.3[医药卫生—骨科学]