术中应用自制跟骨暴露装置预防跟骨骨折术后切口并发症  

The intraoperative self-made calcaneus exposure device in the prevention of postoperative incision complications of calcaneal fracture

作　　者：邹光翼 梁伟 陈佳琦 俞桂松 童培建[2] ZOU Guang-yi;LIANG Wei;CHEN Jia-qi;YU Gui-song;TONG Pei-jian(Dept of Traumatic Orthopaedics,the People′s Hospital of Lishui City,the Sixth Affiliated Hospital of Wenzhou Medical University,the First Affiliated Hospital of Lishui College,Lishui,Zhejiang 323000,China)

机构地区：[1]丽水市人民医院,温州医科大学附属第六医院,丽水学院附属第一医院创伤骨科,浙江丽水323000 [2]浙江省中医院骨伤科,浙江杭州310016

出　　处：《临床骨科杂志》2023年第5期734-738,共5页Journal of Clinical Orthopaedics

基　　金：浙江省卫健委医药卫生科技计划项目(编号:2021PY032);浙江省卫健委中医药科技计划青年人才基金项目(编号:2021ZQ091);温州医科大学2021年度高等教育教学改革项目(编号:JG2021107)。

摘　　要：目的 探讨术中应用自制跟骨暴露装置预防跟骨骨折术后切口并发症的疗效。方法 将69例采用跟骨外侧L形切口入路内固定治疗的跟骨骨折患者(73足)根据术中跟骨暴露方法不同分为常规组(采用3枚克氏针常规暴露跟骨及距下关节面,36足)和自制装置组(采用自制跟骨暴露装置辅助暴露跟骨及距下关节面,37足)。记录术后足部肿胀时间、切口渗出时间、皮缘坏死率、Bohler角、Gissane角、AOFAS踝-后足评分。结果 患者均获得随访,时间12~16个月。两组骨折均愈合,时间3~4个月。两组均无感染病例。足部肿胀时间、切口渗出时间自制装置组均短于常规组(P<0.05)。常规组9足(25.0%)、自制装置组2足(5.4%)发生皮缘坏死,皮缘坏死率自制装置组低于常规组(P<0.05)。Bohler角、Gissane角:两组术后3 d均较术前明显改善(P<0.05);术后3 d两组比较差异均无统计学意义(P>0.05)。末次随访时AOFAS踝-后足评分自制装置组高于常规组(P<0.05)。结论 术中应用自制跟骨暴露装置辅助跟骨外侧L形切口入路内固定治疗跟骨骨折,可减少术后切口并发症的发生,减少复位丢失,有利于骨折愈合。Objective To investigate the effect of intraoperative calcaneal exposure device in the prevention of postoperative incision complications of calcaneal fracture.Methods The 69 patients with calcaneal fractures(73 feet)who were treated by calcaneal lateral L-shaped incision approach internal fixation were divided into conventional group(using 3 Kirschner wires to routinely expose calcaneus and subtalar articular surface,36 feet)and self-made device group(using self-made calcaneal exposure device to assist expose calcaneus and subtalar articular surface,37 feet),according to the different exposure methods of calcaneus.Postoperative swelling time of feet,incision exudation time,calcaneal Bohler angle,Gissane angle and AOFAS ankle-hindfoot score were recorded.Results All patients were followed up for 12~16 months.All fractures healed within 3~4 months.There were no infection cases in each group.The time of foot swelling and incision exudation in the self-made device group were shorter than those in the conventional group(P<0.05).Skin edge necroses occurred in 9 feet(25.0%)of the conventional group and 2 feet of the self-made device group,and the rate of skin edge necroses in the self-made device group was lower than that of the conventional group(P<0.05).Bohler angle and Gissane angle:at 3 d after surgery,two groups were significantly improved than the preoperation(P<0.05),while there was no statistical difference between the two groups(P>0.05).At the last follow-up,the AOFAS ankle-hindfoot scores in the self-made device group were higher than the conventional group(P<0.05).Conclusions During the operation,calcaneal lateral L-shaped incision approach internal fixation assisted with self-made calcaneal exposure device on calcaneal fracture can decrease postoperative incision complications and reduction loss,and it is facilitate to the fracture healing.

关 键 词：跟骨骨折 骨折内固定 术后并发症 自制装置 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]