Schepers Tim, Den Hartog Dennis, Vogels Lucas M M, Van Lieshout Esther M M
Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Foot Ankle Surg. 2013 Mar-Apr;52(2):167-71. doi: 10.1053/j.jfas.2012.11.009. Epub 2013 Jan 11.
The current reference standard for the treatment of displaced intra-articular calcaneal fractures is open reduction and internal fixation using an extended lateral approach. In the present retrospective study, we evaluated the results of a consecutive series of patients treated in the same fashion from June 2005 to September 2011 using a subcuticular single-layer closure technique. We also determined the risk factors for the development of wound complications and the rate of wound complications. Also, we assessed which patient, fracture, and surgical characteristics affected these complications. During the 75-month study period, we operated on 53 displaced intra-articular calcaneal fractures in 50 patients using the extended lateral approach. The incision was closed using the subcuticular technique in 49 cases (92.45%). In the subcuticular closure group 2 (4.1%) deep infections and 2 (4.1%) superficial wound complications (1 dehiscence and 1 infection) occurred. Wound edge or flap necrosis was not encountered. The use of bone-void filler and the experience of the surgical team were significantly (p < .001 and p = .026, respectively) associated with the occurrence of wound complications. The subcuticular single-layer suture technique is a suitable closure technique in the treatment of displaced intra-articular calcaneal fractures. It was associated with a low complication rate combined with the extended lateral approach. The effect of bone void fillers on the incidence of complications should receive more attention in future research. The association between wound complications and the experience level of the surgical team supports the need for centralization of this complex injury.
目前治疗移位性关节内跟骨骨折的参考标准是采用延长外侧入路进行切开复位内固定。在本回顾性研究中，我们评估了2005年6月至2011年9月期间采用皮下单层缝合技术以相同方式治疗的一系列连续患者的结果。我们还确定了伤口并发症发生的危险因素以及伤口并发症的发生率。此外，我们评估了哪些患者、骨折和手术特征会影响这些并发症。在75个月的研究期间，我们对50例患者的53例移位性关节内跟骨骨折采用延长外侧入路进行了手术。49例（92.45%）采用皮下技术关闭切口。在皮下缝合组中，发生了2例（4.1%）深部感染和2例（4.1%）浅表伤口并发症（1例裂开和1例感染）。未遇到伤口边缘或皮瓣坏死。骨缺损填充剂的使用和手术团队的经验分别与伤口并发症的发生显著相关（p <.001和p =.026）。皮下单层缝合技术是治疗移位性关节内跟骨骨折的一种合适的缝合技术。它与延长外侧入路相结合时并发症发生率较低。骨缺损填充剂对并发症发生率的影响在未来研究中应受到更多关注。伤口并发症与手术团队经验水平之间的关联支持了对这种复杂损伤进行集中治疗的必要性。
