治疗Sanders Ⅲ型跟骨骨折切开复位内固定术应用“L”形切口时皮瓣张力的变化

Analysis of change of incision tension in the open reduction and internal fixation using L-shaped incision for the Sander Ⅲ fractures of calcaneus

目的：了解“L”形切口对跟骨Sanders Ⅲ型骨折切开复位内固定术患者术前、术后切口张力的变化。方法对10例跟骨Sanders Ⅲ型骨折患者在术前及术后分别对位于“L”形切口短臂中点（ A）、拐角（ B）、长臂中点（ C）的3个点进行张力测定。结果3个切口点的术后张力均有增加，其中，A点约增加0.076 kg（p〈0.01），B点约增加0.093 kg（ p 〈0.01），C点约增加0.069 kg（p〈0.01）。对3点进行统计学分析显示，3点增加的张力值间比较差异无统计学意义（p〉0.05），3点间切口张力增加值两两比较，差异也无统计学意义（ p〉0.05）。结论应用“L”形切口对SandersⅢ型跟骨骨折进行切开复位内固定术时，术后切口张力都大于术前张力，但都小于相当于1.0 kg，“L”形切口拐角处的皮瓣张力相对于“L”形长、短臂处的张力无明显增大。

Objectives To study the change of incision tension in the open reduction and inter-nal fixation（ORIF）using L-shaped incision for the Sander Ⅲ fractures of calcaneus. Methods Eleven hospitalized patients with Sander Ⅲ fractures of calcaneus underwent ORIF. Tension of three points loca-ted on the long arm（ point A）,the short arm（ point B）and the corner of the L-shaped incision（ point C） were respectively measured and analyzed by student t test using SPSS 17. 0 SOFTWARE. Results The tension of all three points increased compared with the preoperative levels. Increased force was 0. 076 kg （p=3.0＆#215;10 -5）at point A,0.093 kg（p=4.8 ＆#215;10-5）at point B and 0.069 kg（p=2.6 ＆#215;10-5）at point C. The increased incision tension at the three points was not statistically significant（P=0. 189）, and the difference of increased incision tension between every two points was not statistically significant as well（p=0. 209,0. 592,0. 078,respectively）. Conclusion The tension of skin flap will increases after the ORIF for the Sander Ⅲ calcaneal fractures with the L-shaped incision but still below 1. 0 kg. On the other hand,the incision tension on the corner does not markedly increase compared with that on the long arm and short arm.