马黄酊湿敷预防跟骨骨折术后刀口皮瓣坏死的疗效分析

Analysis of the Effect of Wet Dressing of Mahuang Tincture on Preventing Necrosis of Skin Flap After Surgery for Calcaneal Fractures

目的:分析跟骨骨折术后刀口皮瓣坏死出现的原因,评价马黄酊湿敷治疗此骨折术后刀口皮瓣坏死的疗效。方法:75例跟骨骨折患者(共82足)行切开复位、植骨、解剖接骨板内固定术。其中马黄酊组32例35足,给予马黄酊湿敷;乙醇组20例22足,给予乙醇湿敷;常规换药组23例25足,常规换药。三组均采用术后放置负压引流管,常规碘伏换药,加压包扎。结果:马黄酊组32例35足中,2足出现刀口皮瓣坏死,1足出现术后刀口感染,刀口皮瓣坏死率5.71%;乙醇组20例22足中,4足出现刀口皮瓣坏死,1例出现刀口感染,刀口皮瓣坏死率18.18%;常规换药组23例25足,10例出现术后刀口皮瓣坏死,2例出现刀口感染,刀口皮瓣坏死率40%。三组肿胀程度,感染率,皮瓣坏死率比较,差异有统计学意义(P<0.05)。结论:马黄酊湿敷可有效预防跟骨骨折术后刀口皮瓣坏死。

Objective：To analyze the causes of necrosis of skin flap after calcaneal fractures and evaluate the effect of wet dressing of Mahuang tincture on treating necrosis of skin flap after calcaneal fractures. Methods：75 patients（82 feet） with calcaneal fracture were treated with open reduction,bone grafting and anatomical plate internal fixation. After surgery ,all patients were given negative pressure drainage ,routine iodine dressing and pressure dressing. Then divided them into 3 groups. 32 patients （35 feet） in Mahuang tincture group were given Mahuang tincture wet dressing. 20 patients（22 feet） in alcohol group were given alcohol wet dressing . 23 patients （ 25 feet ） in conventional group were given routine dressing . Results：In Mahuang tincture group,2 feet underwent necrosis of skin flap and 1 foot underwent wound infection after surgery. The rate of necrosis of skin flap was 5.71%. In alcohol group, 4 feet underwent necrosis of skin flap and 1 foot underwent wound infection after surgery. The rate of necrosis of skin flap was 18.18%. In conventional group,10 feet underwent necrosis of skin flap and 2 feet underwent wound infection after surgery. The rate of necrosis of skin flap was 40%. The differences of swelling, infection and rate of necro-sis of skin flap among the 3 groups were statistically significant （P＜0.05）. Conclusion：Many factors such as anatomical structure and improper operation can lead to necrosis of skin flap after surgery. When other influencing factors are avoided as much as possible ,Mahuang tincture wet dressing can effectively prevent necrosis of skin flap after surgery for calcaneal fractures.