摘要
目的:分析跟骨骨折切开复位内固定术后切口愈合不良的危险因素。方法:选取91例(91足)采用切开复位内固定术治疗的闭合性跟骨骨折患者作为研究对象。男66例,女25例;年龄22~80岁,中位数47岁;高处坠落伤79例,车祸伤12例;按照Sanders分型标准,Ⅱ型40例、Ⅲ型39例、Ⅳ型12例;伤后至手术时间3 h至15 d,中位数9 d。收集患者的病例资料,提取年龄、性别、骨折类型、血清白蛋白水平、伤后至手术时间、是否进行人工骨植骨、手术时间、切口缝合方式、切口愈合情况等信息。先采用单因素分析对自变量进行筛选,再通过Logistic回归分析确定跟骨骨折切开复位内固定术后切口愈合不良的危险因素。结果:术后13例切口愈合不良(愈合不良组),其中8例患者出现切口皮缘坏死或裂开、5例发生切口浅表感染,其余78例患者切口愈合良好(愈合良好组)。愈合不良组和愈合良好组骨折类型、低白蛋白血症(血清白蛋白<35 g·L^(-1))、伤后至手术时间、手术时间、切口缝合方式比较,组间差异均有统计学意义(χ~2=10.202,P=0.006;χ~2=6.398,P=0.011;χ~2=3.863,P=0.049;χ2=4.658,P=0.031;χ~2=8.729,P=0.003)。以切口愈合情况为因变量,将单因素分析结果中有意义的5个因素纳入多因素Logistic回归分析,结果显示低白蛋白血症(OR=1.757,P=0.000)、伤后至手术时间<7 d(OR=3.324,P=0.015)、手术时间>90 min(OR=4.379,P=0.003)及切口褥式缝合(OR=1.254,P=0.004)是跟骨骨折切开复位内固定术后切口愈合不良的危险因素。结论:低白蛋白血症、伤后至手术时间<7 d、手术时间>90 min及切口褥式缝合是跟骨骨折切开复位内固定术后切口愈合不良的危险因素。
Objective ： To analyze the risk factors for poor healing of incision after open reduction and internal fixation for treatment of calcaneus fractures. Methods：Ninety -one patients（91 feet）with closed calcaneus fractures who had been treated with open reduction and internal fixation were selected as the subjects. The patients consisted of 66 males and 25 females, and ranged in age from 22 to 80 years （Median = 47 yrs） and ranged in disease course from 3 hours to 15 days（ Median = 9 days）. The fractures were caused by high falling inju-ries （79 ）and traffic accident injuries （ 12） ,and the fractures belonged to types II （40 ） , IH （ 39 ） and IV （ 12 ） according to Sanders classifica-tion standard. The medical records of these patients were collected and the information about age,gender,fracture type,serum level of albu- min,time from injury to surgery, artificial bone grafting, operative time, incision suturing method and incision healing were extracted for analysis. The independent variables were screened by using single - factor analysis and the risk factors for poor healing of incision after open reduction and internal fixation for treatment of calcaneus fractures were confirmed by using Logistic regression analysis. Results： The postop-erative poor - healed incisions were found in 13 patients（ poor - healed group） , including skin necrosis or rupture at the incision margin（ 8 ） and superficial incision infection（5 ） , and incisions healed well in the other patients（ well - healed group）. There was statistical difference in fracture type,hypoalbuminemia（ serum albumin 〈35 g/L） ,time from injury to surgery,operative time and incision suturing method be-tween poor - healed group and well - healed group（x^2 = 10. 202 ,P = 0. 006;x^= 6. 398 , P = 0. 011 ;x^2 = 3. 863 ,P =0. 049 ;x^= 4. 658 , P =0. 031 =8. 729,P =0. 003） . The incision healing was chosen as the dependent variable and the five significative factors chosen fromthe results of single - factor analysis were included in multiple - factor Logistic regression analysis. Finally the results demonstrated that hy- poalbuminemia（ OR = 1. 151 ,P = 0. 000） , time from injury to surgery of 〈 7 days（ OR = 3. 324 ,P = 0. 015 ） , operative time of 〉 90 minutes （ OR =4. 379 ,P =0. 003 ） and incision mattress - suture（ OR = 1.254 ,P = 0. 004） were the risk factors for postoperative poor healing of in-cision following open reduction and internal fixation for treatment of calcaneus fractures. Conclusion ： Hypoalbuminemia, time from injury to surgery of 〈7 days, operative time of 〉90 minutes and incision mattress - suture are the risk factors for postoperative poor healing of inci-sion following open reduction and internal fixation for treatment of calcaneus fractures.
作者
陆义安
薛锋
LU Yian;XUE Feng(Fengxian District Central Hospital,Shanghai 201499, China)
出处
《中医正骨》
2018年第4期43-45,共3页
The Journal of Traditional Chinese Orthopedics and Traumatology
