Hao Dongsheng, Chen Chen, Wang Dong, Yin Yunsheng
Department of Orthopedics, Shanxi Academy of Medical Sciences, Shanxi Grand Hospital, Taiyuan Shanxi, 030009, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Jan;27(1):30-5.
To analyze the non-operation related risk factors of the wound complications by using lateral extensive L-shaped incision for open reduction and internal fixation of calcaneal fractures.
A retrospective analysis was made on the clinical data of 58 patients with closed calcaneal fractures (63 calcaneus) treated by using lateral intensive L-shaped incision for open reduction and internal fixation between September 2006 and August 2011. There were 52 males (56 calcaneus) and 6 females (7 calcaneus), aged 18 to 64 years (mean, 35 years). The causes of injury included fall injury in 53 cases (58 calcaneus), traffic injury in 5 cases (5 calcaneus). The mean time between injury and operation was 8 days (range, 3-22 days). According to Sanders classification, 4 calcaneus were rated as type II, 31 calcaneus as type III, and 28 calcaneus as type IV. Postoperative complications were observed and graded; 58 patients were divided into complication group (> or = grade 2) and control group (< grade 2). The univariate analysis was used to analyze 18 factors which may lead to wound complications; multi-factor unconditioned logistic regression analysis was done for the factors showing significant difference.
According to postoperative wound complications grading, 41 patients (46 calcaneus) were included in the control group, whose incision healed primarily, and 17 patients (17 calcaneus) in the complication group. In 17 patients of the complication group, 14 had skin necrosis or dehiscence, and 3 had superficial infection; they obtained healing after symptomatic treatment. The univariate analysis showed significant differences in combined spinal fracture, diabetes mellitus, and long-term smoking between 2 groups (P < 0.05). The logistic regression analysis revealed that combined spinal fracture was an independent risk factor for wound complications (95% confidence interval: 0.004-0.360, P = 0.004).
Combined spinal fracture is an independent risk factor for wound complications after open reduction and internal fixation of calcaneal fracture using lateral extensive L-shaped incision.
分析采用外侧扩大L形切口切开复位内固定跟骨骨折时伤口并发症的非手术相关危险因素。
回顾性分析2006年9月至2011年8月采用外侧扩大L形切口切开复位内固定治疗的58例闭合性跟骨骨折患者（63侧跟骨）的临床资料。其中男52例（56侧跟骨），女6例（7侧跟骨），年龄18～64岁，平均35岁。致伤原因：坠落伤53例（58侧跟骨），交通伤5例（5侧跟骨）。受伤至手术的平均时间为8天（范围3～22天）。按Sanders分型，Ⅱ型跟骨4侧，Ⅲ型31侧，Ⅳ型28侧。观察术后并发症并分级；将58例患者分为并发症组（≥2级）和对照组（<2级）。采用单因素分析对18个可能导致伤口并发症的因素进行分析；对差异有统计学意义的因素进行多因素非条件logistic回归分析。
根据术后伤口并发症分级，对照组41例患者（46侧跟骨）切口一期愈合，并发症组17例患者（17侧跟骨）。并发症组17例患者中,14例出现皮肤坏死或裂开，3例出现浅表感染，经对症处理后愈合。单因素分析显示，两组在合并脊柱骨折、糖尿病、长期吸烟方面差异有统计学意义（P<0.05）。logistic回归分析显示，合并脊柱骨折是伤口并发症的独立危险因素（95%可信区间：0.004～0.360，P=0.004）。
合并脊柱骨折是采用外侧扩大L形切口切开复位内固定跟骨骨折术后伤口并发症的独立危险因素。
