Allgöwer-Donati缝合法与垂直褥式缝合法对踝关节骨折手术中灌注的影响：一项使用术中血管造影的随机临床试验
Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative Angiography.
作者信息
Shannon Steven F, Houdek Matthew T, Wyles Cody C, Yuan Brandon J, Cross William W, Cass Joseph R, Sems Stephen A
机构信息
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
出版信息
J Orthop Trauma. 2017 Feb;31(2):97-102. doi: 10.1097/BOT.0000000000000731.
OBJECTIVE
The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography: Allgöwer-Donati or vertical mattress.
DESIGN
Prospective, randomized.
SETTING
Level 1 Academic Trauma Center.
PATIENTS/PARTICIPANTS: Thirty patients undergoing open reduction internal fixation for ankle fractures were prospectively randomized to Allgöwer-Donati (n = 15) or vertical mattress (n = 15) closure. Demographics were similar for both cohorts with respect to age, sex, body mass index, surgical timing, and OTA/AO fracture classification.
MAIN OUTCOME MEASUREMENTS
Skin perfusion (mean incision perfusion and mean perfusion impairment) was quantified in fluorescence units with laser-assisted indocyanine green angiography along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow-up 4.7 months.
RESULTS
Allgöwer-Donati enabled superior perfusion compared with the vertical mattress suture technique. Mean incision perfusion for Allgöwer-Donati was 51 (SD = 13) and for vertical mattress was 28 (SD = 10, P < 0.0001). Mean perfusion impairment was less in the Allgöwer-Donati cohort (12.8, SD = 9) compared with that in the vertical mattress cohort (23.4, SD = 14; P = 0.03). One patient in each cohort experienced a wound complication.
CONCLUSIONS
The Allgöwer-Donati suture technique offers improved incision perfusion compared with vertical mattress closure after open reduction internal fixation of ankle fractures. Theoretically, this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures.
LEVEL OF EVIDENCE
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
目的
本研究旨在评估踝关节骨折采用哪种一期伤口闭合技术，通过激光辅助吲哚菁绿血管造影术测量，能提供最强大的灌注：Allgöwer-Donati缝合法或垂直褥式缝合法。
设计
前瞻性、随机对照研究。
地点
一级学术创伤中心。
患者/参与者：30例行踝关节骨折切开复位内固定术的患者被前瞻性随机分为Allgöwer-Donati缝合法组（n = 15）和垂直褥式缝合法组（n = 15）。两组在年龄、性别、体重指数、手术时机和OTA/AO骨折分类方面的人口统计学特征相似。
主要观察指标
在30个不同位置，通过激光辅助吲哚菁绿血管造影术，以荧光单位量化沿外侧切口以及切口前后的皮肤灌注（平均切口灌注和平均灌注损伤）。最短随访时间为3个月，平均随访时间为4.7个月。
结果
与垂直褥式缝合法相比，Allgöwer-Donati缝合法能实现更好的灌注。Allgöwer-Donati缝合法的平均切口灌注为51（标准差 = 13），垂直褥式缝合法为28（标准差 = 10，P < 0.0001）。Allgöwer-Donati缝合法组的平均灌注损伤（12.8，标准差 = 9）低于垂直褥式缝合法组（23.4，标准差 = 14；P = 0.03）。每组各有1例患者发生伤口并发症。
结论
踝关节骨折切开复位内固定术后，与垂直褥式缝合法相比，Allgöwer-Donati缝合法可改善切口灌注。从理论上讲，这可能会促进软组织愈合并降低伤口并发症的风险。外科医生在决定踝关节骨折的闭合技术时可考虑这一点。
证据级别
治疗性一级。有关证据级别的完整描述，请参阅作者指南。
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