改良体位在Cotton骨折手术中的临床应用  

Clinical application of reforming posture in the operation of Cotton fracture

作　　者：刘张冰 谢鹏[2] 洪剑飞[3] 

机构地区：[1]贵州省遵义市红花岗区人民医院,遵义563000 [2]贵州省遵义医学院人体解剖学教研室 [3]浙江省人民医院

出　　处：《浙江创伤外科》2015年第5期836-838,共3页Zhejiang Journal of Traumatic Surgery

基　　金：国家自然科学基金(项目编号:31360256)

摘　　要：目的 探讨改良体位在Cotton骨折手术中的临床应用效果。方法 收集2008年12月至2013年12月,同组医生对42例Cotton骨折患者实行手术治疗的临床资料。其中男性34例,女性8例;年龄18-42岁,平均（29.5±7.3）岁。将其随机分为观察组（改良组）22例和对照组（俯卧组）20例,骨折复位固定顺序为外踝-后踝-下胫腓联合-内踝。术后统计两组患者的手术时间、术中出血量、切口愈合时间及骨折愈合时间,并采用t检验对比分析。结果 42例患者均获随访,随访时间12-18个月,平均（15±3.1）个月。平均手术时间：观察组84.2分钟,对照组110.7分钟（P〈0.05）。平均术中出血量：观察组100.9ml,对照组162.1 ml（P〈0.05）。平均切口愈合时间：观察组12.5天,对照组14.2天（P〉0.05）。骨折平均愈合时间：观察组16.2周,对照组17.3周（P〉0.05）。结论 改良体位在Cotton骨折手术中临床效果优于俯卧位,能明显缩短手术时间,减少术中出血,减轻手术创伤,又能充分显露术野,而且操作简单方便,值得临床推广应用。Objective To investigate the effect of clinical application for reforming posture in the operation of Cotton fracture. Methods From December 2008 to December 2013, 42 cases patients with Cotton fracture were treated by the same surgeons, including 34 males and 8 females, aged 18 to 42 years, mean （29.5 ±7.3） years. All patients were randomly divided into observation and control group. 22 cases were enrolled in observation group （improved group） while 20 in control group （prone position group）. The sequence of reduction and fixation of Cotton fractures was firstly lateral malleolus, then posterior malleolus and inferior tibiofibular syndesmosis,and medial malleolus lastly. The operating time, blood loss during surgery, incision healing time and fracture healing time after operation. The results were compared and analyzed with the t test between the two groups. Results All the patients were followed up for 12 to 18 months, average （15 ±3.1） months. The mean operating time in the observation and control groups respectively was 84.2min and 110.7min（P〈0.05）, mean blood loss during surgery respectively was 100.9ml and 162.1ml（P〈0.05）, mean incision healing time respectively was 12.5d and 14.2d （P〉0.05）, and mean fracture healing time respectively is 16.2w and 17.3w （P〉0.05）. Conclusions The reforming posture is better than the prone position to clinical effect in the operation of Cotton fracture.It could obviously shorten operation time, reduce intraoperative blood loss, alleviate operative trauma and exposure the operative field sufficiently. The operational approach is simple and convenient and deserves the clinical expansion application.

关 键 词：改良体位 COTTON骨折 踝关节 

分 类 号：R683.4[医药卫生—骨科学]