外固定架联合双层VSD治疗开放性跟骨骨折的效果及对Maryland足部评分、伤口愈合时间的影响  

External fixator combined with double-layer VSD for open calcaneal fracture and its effect on Maryland foot score and wound healing time

作　　者：高学柱[1] 张士平[1] 陆伟[1] Gao Xuezhu;Zhang Shiping;Lu Wei(Tengzhou Central People's Hospital, Tengzhou 277500, China)

机构地区：[1]滕州市中心人民医院,277500

出　　处：《国际医药卫生导报》2019年第5期739-743,共5页International Medicine and Health Guidance News

摘　　要：目的探究外固定架联合双层VSD治疗开放性跟骨骨折的效果及对Maryland足部评分、伤口愈合时间的影响。方法选择2017年3月至2018年3月本院收治的跟骨骨折患者90例,随机分为对照组与观察组。两组患者均接受复位手术外固定架治疗,对照组患者进行普通换药处理,观察组患者联合双层VSD治疗。比较两组影像学数据、伤口愈合时间、预后和Maryland评分。检测并比较两组炎症因子和氧化应激水平。结果术后两组各项影像学指标均显著改善(均P<0.05);术后1个月,观察组Bohler角、Gissane角和跟骨高度显著高于对照组([25.73±0.98)°比(22.01±1.24)°,(125.45±1.02)°比(120.58±1.56)°,(60.46±1.54)mm比(57.44±1.41)mm],而内侧缩短率显著低于对照组([14.37±0.54)%比(20.56±1.64)%,均P<0.05]。观察组伤口愈合时间、切口感染率和接受皮瓣转移术患者的比例均显著低于对照组[(26.63±3.24)d比(43.48±5.67)d,6.67%比24.44%,0.00%比11.11%,均P<0.05]。术后两组炎性因子水平均显著升高(均P<0.05);术后7d,观察组血清CPR、TNF-α均显著低于对照组[39.67±2.93)pg/ml比(48.45±5.25)pg/ml、(26.97±3.43)pg/ml比(32.21±3.97)pg/ml,均P<0.05]。术后7d,观察组血清MDA水平显著低于对照组[(4.54±0.86)nmol/ml比(5.04±0.90)nmol/ml],SOD显著高于对照组[(51.76±4.87)U/ml比(46.87±4.67)U/ml,均P<0.05]。术后1个月,观察组Maryland评分显著高于对照组[(90.37±5.12)分比(78.43±4.63)分,P<0.05]。结论外固定架联合双层VSD治疗开放性跟骨骨折具有更好的效果,可提高Maryland足部评分,促进伤口愈合,此外联合双层VSD可有效降低炎症反应和氧化应激反应。Objective To explore the effect of external fixation combined with double-layer VSD in the treatment of open calcaneal fracture and the impact on Maryland foot score and wound healing time. Methods Ninety patients with calcaneal fracture treated at our hospital from March, 2017 to March, 2018 were randomly divided into a control group and an observation group. Both groups were treated with external fixation with a reduction surgery. The control group were treated with normal dressing, and the observation group with doublelayer VSD. The imaging data, wound healing time, prognosis, and Maryland score were compared between the two groups. The levels of inflammatory factors and oxidative stress were measured and compared between the two groups. Results The imaging indicators of the two groups were significantly improved after the operation (all P < 0.05). One month after the operation, the Bohler angle, Gissane angle, and calcaneus height were higher and the medial shortening rate was significantly lower in the observation group than in the control group [(25.73±0.98)° vs.(22.01±1.24)°,(125.45±1.02)° vs.(120.58±1.56)°,(60.46±1.54) mm vs.(57.44±1.41) mm, and (14.37±0.54)% vs.(20.56±1.64)%, all P < 0.05]. The wound healing time, incision infection rate, and the proportion of the patients undergoing flap transfer were significantly lower in the observation group than in the control group [(26.63±3.24) d vs.(43.48±5.67) d, 6.67% vs. 24.44%, and 0.00% vs. 11.11%, all P < 0.05]. The levels of inflammatory factors were significantly increased in the two groups (all P < 0.05). The serum levels of CPR and TNF-α were significantly lower in the observation group than in the control group [(39.67±2.93) pg/ml vs.(48.45±5.25) pg/ml and (26.97±3.43) pg/ml vs.(32.21±3.97) pg/ml, both P < 0.05]. The serum level of MDA was significantly lower and the serum level of SOD and Maryland foot score were significantly higher in the observation group than in the control group [(4.54±0.86) nmol/ml vs.(5.04±0.90) nmol/ml,(5

关 键 词：跟骨骨折 外固定支架 负压引流 足部功能 

分 类 号：R687.3[医药卫生—骨科学]