跟骨骨折外侧延长L形切口并发症非手术相关危险因素分析

NON-OPERATION RELATED RISK FACTORS OF WOUND COMPLICATIONS OF CALCANEAL FRACTURES USING LATERAL EXTENSIVE L-SHAPED INCISION

目的探讨采用外侧延长L形切口行跟骨骨折切开复位内固定术后切口并发症的非手术相关危险因素。方法回顾分析2006年9月-2011年8月58例63足经外侧延长L形切口行切开复位内固定的闭合性跟骨骨折患者临床资料。男52例56足,女6例7足;年龄18～64岁,平均35岁。致伤原因:坠落伤53例58足,交通事故伤5例5足。伤后至手术时间3～22 d,平均8 d。骨折根据Sanders分型标准分型:Ⅱ型4足,Ⅲ型31足,Ⅳ型28足。观察术后切口并发症发生情况并分级,其中分级≥2级列入并发症组,<2级列入对照组。对可能导致切口并发症的18个变量进行单因素分析,对差异有统计学意义的变量进行多因素非条件logistic回归分析。结果 41例46足切口Ⅰ期愈合,纳入对照组;17例17足出现2级及以上切口并发症,纳入并发症组。其中皮肤坏死、红肿或裂开14例,浅表感染3例,均经对症处理后愈合。单因素分析显示,脊柱骨折、糖尿病及吸烟史3个变量差异有统计学意义(P<0.05);多因素分析显示,脊柱骨折为独立危险因素(95%可信区间:0.004～0.360,P=0.004)。结论合并脊柱骨折是采用外侧延长L形切口行跟骨骨折切开复位内固定术后发生切口并发症的独立危险因素。

Objective 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. Methods 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 （≥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. Results 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）. Conclusion 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.