跟骨骨折后跟骨骨髓炎的流行病学和临床特征：127 例回顾性研究。
The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases.
机构信息
Department of Orthopedics, Tongde Hospital of Zhejiang, Hangzhou, China.
出版信息
Ann Palliat Med. 2021 Mar;10(3):3154-3161. doi: 10.21037/apm-21-208.
BACKGROUND
To analyze the epidemiology and features of calcaneus osteomyelitis following open reduction and internal fixation (ORIF) after closed calcaneus fracture.
METHODS
We retrospectively analyzed 127 cases who were diagnosed with calcaneal osteomyelitis following ORIF via the extended lateral "L-shaped" approach after closed calcaneus fracture between March 2016 and August 2019 in our hospital. We analyzed participant demographics including gender, age, body mass index (BMI), trauma mechanism, Sanders classification, co-morbidity, time between initial injury and surgery, operating time, soft tissue stripping tools, tourniquet pressure, bone grafting option, internal fixation option, presence of bleeding after tourniquet deflation, and drainage option.
RESULTS
The majority of cases (n=127) were male (4.5 times more than female gender), at a ratio of 4.47:1. Falling from height was the main trauma mechanism (79.53%), followed by traffic accident (14.17%), and jumping (6.3%). A total of 51 cases (40.16%) were left-side fractures, and 76 (59.84%) were right-sided. According to the Sanders classification, 12 cases were type II (9.45%), 61 cases were type III (48.03%), and 54 cases were type IV (42.52%). There were 25 participants with the co-morbidity of type 2 diabetes mellitus (19.69%), 7 with hypertension (5.51%), and 1 case each of psoriasis and sicca syndrome (0.8%). The mean time to surgery was 4.7 days (4-9 days), and 123 participants (96.85%) were treated within 7 days. The mean operating time was 102.1 min (75-135 min). Forty-four participants (34.65%) received the conventional scalpel and 83 participants (65.35%) the electric scalpel during soft tissue stripping intraoperatively. The mean tourniquet pressure was 432.3 mmHg (350-550 mmHg). Autologous bone grafting was observed in 6 cases (4.72%), allograft bone grafting in 11 cases (8.67%), and OsteoSet grafting in 7 cases (5.51%). A locking plate was used in 114 cases (89.76) while anatomical plate in 13 cases (10.24%). A total of 27 participants (21.26%) bled after tourniquet deflation. Drainage tubes were applied in 30 participants (23.62%) while rubber drainage strips in 5 participants (3.94%).
CONCLUSIONS
Young males dominated the calcaneus osteomyelitis following traumatic calcaneus fracture cohort in this study. A fall from height was the most frequent trauma mechanism. The presence of severe calcaneus fracture, Sanders type III (48.03%) and type IV (42.52%), were the common fracture types in this population group.
背景
分析跟骨骨折闭合复位内固定（ORIF）后发生跟骨骨髓炎的流行病学和特征。
方法
我们回顾性分析了 2016 年 3 月至 2019 年 8 月期间我院采用外侧“L”形延长切口对闭合性跟骨骨折行 ORIF 后发生跟骨骨髓炎的 127 例患者。我们分析了患者的人口统计学资料，包括性别、年龄、体重指数（BMI）、创伤机制、桑德斯分类、合并症、初次损伤与手术的时间间隔、手术时间、软组织剥离工具、止血带压力、植骨选择、内固定选择、止血带放气后出血情况以及引流选择。
结果
大多数病例（n=127）为男性（是女性的 4.5 倍），男女比例为 4.47:1。高处坠落是主要的创伤机制（79.53%），其次是交通事故（14.17%）和跳跃（6.3%）。51 例（40.16%）为左侧骨折，76 例（59.84%）为右侧。根据桑德斯分类，12 例为 II 型（9.45%），61 例为 III 型（48.03%），54 例为 IV 型（42.52%）。25 例患者合并 2 型糖尿病（19.69%），7 例合并高血压（5.51%），1 例合并银屑病和干燥综合征（0.8%）。手术时间平均为 4.7 天（4-9 天），123 例（96.85%）在 7 天内接受治疗。平均手术时间为 102.1 分钟（75-135 分钟）。44 例（34.65%）患者术中采用传统手术刀，83 例（65.35%）患者采用电手术刀进行软组织剥离。平均止血带压力为 432.3mmHg（350-550mmHg）。6 例（4.72%）患者接受自体骨移植，11 例（8.67%）患者接受同种异体骨移植，7 例（5.51%）患者接受 OsteoSet 移植。114 例（89.76%）患者采用锁定钢板，13 例（10.24%）患者采用解剖钢板。27 例（21.26%）患者止血带放气后出血。30 例（23.62%）患者应用引流管，5 例（3.94%）患者应用橡胶引流条。
结论
在这项研究中，年轻男性是创伤性跟骨骨折后发生跟骨骨髓炎的主要人群。高处坠落是最常见的创伤机制。该人群中常见的骨折类型为严重跟骨骨折，桑德斯 III 型（48.03%）和 IV 型（42.52%）。
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