钉合与缝合跟骨骨折手术切口的疗效比较  

Comparison of the therapeutic effects of stapling and suturing in calcaneal skin incision

作　　者：董瑞一[1] 王丽华[1] 买丽丽[1] 苑娜[1] 郑继会[1] 武永东[1] 魏金栋[1] DONG Ruiyi;WANG Lihua;MAI Lili;YUAN Na;ZHENG Jihui;WU Yongdong;WEI Jindong(Department of Orthopaedics Trauma, Cangzhou Hospital of Integrated TCM-WM Hebei, Cangzhou 061011, China)

机构地区：[1]河北省沧州中西医结合医院创伤骨科,061011

出　　处：《国际骨科学杂志》2021年第5期319-322,328,共5页International Journal of Orthopaedics

基　　金：沧州市科学计划自筹经费项目(183302119)。

摘　　要：目的 比较钉合与缝合两种方法闭合跟骨骨折手术切口的疗效。方法 根据纳入及排除标准,纳入河北省沧州中西医结合医院2018年1月至2020年1月收治的跟骨骨折患者96例,按照随机数表法分为A组(钉合组)和B组(缝合组),每组48人。两组均采用切开复位内固定治疗,A组采用一次性皮肤缝合器钉合切口,B组采用强生普通1号丝线缝合切口。比较两组闭合切口速度、术后切口渗出持续时间,采用疼痛视觉模拟评分(VAS)评估术后第1、3天及切口愈合后拆钉(线)时的疼痛程度。观察术后两组炎性反应、皮缘坏死、切口裂开、内固定物外露、切口感染、过敏反应发生率及术后3个月时切口“蜈蚣状”瘢痕发生率。结果 所有患者术后均获得3个月的随访。A组闭合切口速度明显快于B组,皮缘坏死率、“蜈蚣状”瘢痕发生率及拆钉(线)时疼痛VAS评分明显低于B组,差异有统计学意义(P<0.05)。两组炎性反应、切口裂开、切口感染发生率和术后渗出时间以及第1、3天疼痛VAS评分差异无统计学意义(P>0.05)。两组均未出现内固定物外露及过敏反应等并发症。结论 钉合跟骨手术切口可以缩短手术时间,降低手术并发症发生率,减轻患者痛苦,且能达到较好的美容效果,具有较大的应用价值。Objective To compare the efficacy of stapling and suture in closing the incision of calcaneal fractures.Methods From January 2018 to January 2020,96 patients with calcaneal fracture in Cangzhou Hospital of Integrated TCM-WM Hebei were included according to the inclusion and exclusion criteria and were randomly divided into group A(stapling group)and group B(suture group),with 48 in each group.Both groups were treated with open reduction and plate screw internal fixation.In group A,the incision was closed with skin staplers,and in group B,the incision was sutured with Johnson&Johnson ordinary No.1 silk thread.The suture speed,duration of incision exudation after operation,degree of pain(VAS score)on the first and third days after operation and at the time of staple/thread removal were compared.The incidence of inflammatory reaction,skin edge necrosis,incision dehiscence,plate exposure,incision infection,allergic reaction(rash),and incision"centipede"scar at the third month after operation were observed.Results All patients were followed up for three months.The closure speed of group A was significantly faster than that of group B.The rates of skin edge necrosis,centipede occurrence,and pain VAS scores in group A were significantly lower than those in group B(P<0.05).There were no significant differences in inflammatory reaction,incision dehiscence,plate exposure,incision infection,incidence of allergic reaction,postoperative exudation time,and pain degree on the first and third days between the two groups(P>0.05).There were no complications such as plate exposure or allergic reaction in either group.Conclusion Stapling calcaneal incisions offers faster suture speed,lower skin edge necrosis rate,less severe pain degree,and better cosmetic effect,which combine to create excellent application value.

关 键 词：钉合 跟骨骨折 缝合 切口 皮缘坏死 

分 类 号：R65[医药卫生—外科学]