多次减张缝合治疗跟骨骨折术后皮肤坏死的临床疗效观察  

Clinical Observation on Repair of Small Range Necrosis of Skin after ORIF of Calcaneal Fractures with Multiple relaxation Suture

作　　者：吴国忠[1] 王文怀[1] 林三福[1] 陈守勃[1] WU Guozhong;WANG Wenhuai;LIN Sanfu;CHEN Shoubo(The Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院,福建泉州362000

出　　处：《中国医学创新》2020年第31期159-164,共6页Medical Innovation of China

摘　　要：目的:探讨采用多次减张缝合治疗跟骨骨折术后小范围皮肤坏死的疗效。方法:选取2015年1月-2018年12月期间因采用外侧"L"形切口治疗跟骨骨折术后出现小范围皮肤坏死的22例患者,皮肤坏死界限清楚后行扩创、多次减张缝合皮肤牵张处理,首次扩创减张缝合术在骨折术后10-21 d,平均18 d。记录减张缝合皮肤牵张手术次数、切口愈合情况及相关并发症。结果:减张缝合手术次数中2次有4例,3次有8例,4次有8例,5次有2例,创面均甲级愈合。首次扩创至伤口愈合为22-45 d,平均(31±7) d,骨折术后到伤口愈合为39-60 d,平均(50±7)d。所有患者均保留了钢板内固定物,骨折愈合时间平均3.5个月。术后1年B?hler角和Gissane角比较骨折术后第2天比较,差异均无统计学意义(P>0.05)。术后1年按AOFAS踝与后足功能评分标准评定:8例优,10例良,4例可,优良率81.8%。术后1年参照英国医学研究会(BMRC)感觉功能评定标准对足部外侧皮肤感觉神经功能评级:18例S4,4例S2。结论:多次减张缝合处理跟骨骨折术后小范围皮肤坏死,技术操作简单,创面愈合好,保留了内固定物,保留了皮肤感觉功能。Objective:To investigate clinical observation on repair of small range necrosis of skin after ORIF of calcaneal fractures with multiple relaxation suture for skin extension technique.Method:From January 2015 to December 2018,22 patients who had a small area of skin necrosis after surgery for fractured calcaneus with "L" lateral incision were selected.When the boundaries of skin necrosis was clear,expanding debridement and multiple relaxation suture for skin extension technique were put into effect.The first time for expanding debridement and relaxation suture was performed 10-21 days after fracture operation,with an average of 18 days.The times of relaxation suture surgery,incision healing results and related complications were recorded.Result:The times of relaxation suture surgery were as follows:4 cases were operated twice,8 cases of 3 times,8 cases of 4 times and 2 case of 5 times.All wound recovered in grade a healing.The wound healing time was from 22 to 45 days,mean (31±7) days after the first time for expanding debridement and relaxation suture,after surgery for fractured calcaneus was from 39 to 60 days,mean (50±7) days.All patients retained intraplate fixation,the time of fracture healing was an averaged of 3.5 months.There was no statistical differences between the B?hler angle and Gissane angle of 2nd day after operation and 1 year after operation (P>0.05).The ankle joint function was evaluated according to AOFAS ankle and posterior foot function score as follows:8 cases were excellent,10 cases were good,4 cases were acceptable,the excellent and good rate was 81.8% one year after operation.According to the British Medical Research Council (BMRC) sensory function assessment system,the rating of sensory nerve function on the lateral foot skin was evaluated one year after operationas as follows:18 cases were rated as S4 and 4 cases as S2.Conclusion:The repair of small range Necrosis of skin after ORIF of calcaneal fractures with multiple relaxation suture for skin extension technique is easy to carry ou

关 键 词：跟骨骨折 皮肤坏死 皮瓣坏死 减张缝合 皮肤牵张术 

分 类 号：R687.3[医药卫生—骨科学]