Zhang Zitao, Wang Zhen, Zhang Yan, Qiu Xusheng, Chen Yixin
Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing Medical University Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing Department of Intensive Care Unit, The First People's Hospital of Changshu, Changshu, P.R. China.
Medicine (Baltimore). 2018 Aug;97(32):e11818. doi: 10.1097/MD.0000000000011818.
Sufficient drainage is very important for preventing wound complications after open reduction and internal fixation (ORIF) of calcaneal fractures. However, the drainage amount varies among patients. The objective of this study was to identify factors associated with increased postoperative drainage after ORIF of calcaneal fractures.A retrospective study including 87 patients with 92 calcaneal fractures in our hospital was performed. Patients were divided into 2 groups based on whether they had increased drainage, which was defined as a total drainage of ≥340 mL (50th percentile). We gathered the following data on each patient: age; sex; smoking history; body mass index (BMI); American Society of Anesthesiologists (ASA) classification; fracture type; the time from injury to surgery; operative time; bone grafting; preoperative labs including prothrombin time (PT), activated partial thromboplastin time (APTT), hematocrit, and D-dimer level; and histories for hypertension, diabetes, and heart disease. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors associated with increased drainage.Total drainage ranged from 105 to 1185 mL, and the average drainage for this cohort was 393.6 ± 232.4 mL (mean ± standard deviation). 57.6% (n = 53) of patients had increased drainage. Smoking history, Sanders type, operative time, and bone grafting were significantly associated with increased drainage on univariate analysis. Multivariate logistic regression analysis then demonstrated that active smoking and higher Sanders type were independent risk factors for increased drainage.Patients with calcaneal fractures who smoked or had a higher level of Sanders type had a higher risk of increased postoperative drainage. Therefore, we suggest that active precautions be taken for these patients to reduce the rate of postoperative wound complications.
充分引流对于跟骨骨折切开复位内固定术（ORIF）后预防伤口并发症非常重要。然而，患者之间的引流量各不相同。本研究的目的是确定跟骨骨折ORIF术后引流量增加的相关因素。
我们对我院87例92处跟骨骨折患者进行了一项回顾性研究。根据患者引流量是否增加将其分为两组，引流量增加定义为总引流量≥340毫升（第50百分位数）。我们收集了每位患者的以下数据：年龄；性别；吸烟史；体重指数（BMI）；美国麻醉医师协会（ASA）分级；骨折类型；受伤至手术的时间；手术时间；植骨情况；术前实验室检查结果，包括凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血细胞比容和D - 二聚体水平；以及高血压、糖尿病和心脏病史。采用单因素分析和多因素logistic回归分析来分析与引流量增加相关的危险因素。
总引流量为105至1185毫升，该队列的平均引流量为393.6±232.4毫升（均值±标准差）。57.6%（n = 53）的患者引流量增加。单因素分析显示，吸烟史、Sanders分型、手术时间和植骨与引流量增加显著相关。多因素logistic回归分析表明，主动吸烟和较高的Sanders分型是引流量增加的独立危险因素。
吸烟或Sanders分型较高的跟骨骨折患者术后引流量增加的风险更高。因此，我们建议对这些患者采取积极的预防措施，以降低术后伤口并发症的发生率。
