马黄酊湿敷与改良Donati-Allgower缝合法治疗跟骨骨折疗效观察

Clinical Observation on Mahuangding Wet Packing Combined with Improved Donati- Allgower Suture in Treating Calcaneal Fractures

目的 :分析跟骨骨折术后出现刀口皮瓣坏死的原因,评价改良Donati-Allgower缝合法与马黄酊湿敷预防跟骨骨折术后刀口皮瓣坏死等并发症的疗效。方法:89例跟骨骨折患者行切开复位+解剖接骨板内固定+植骨术。单纯缝合组(A1组)22例22足,单纯缝合并马黄酊湿敷组(A2组)22例22足,改良Donati-Allgower缝合组(B1组)22例23足,改良Donati-Allgower缝合并马黄酊湿敷组(B2组)23例24足。结果:A1、A2、B1、B2四组中,出现刀口皮瓣坏死足数分别为9足、6足、5足、2足;出现刀口感染足数分别为3足、1足、1足、0足;刀口皮瓣坏死率分别为40.9%、27.3%、21.7%、4.3%;刀口平均愈合时间分别为(15.55±0.35)d、(14.36±0.42)d、(17.35±0.31)d、(16.88±0.21)d。A1、A2、B1各组感染率、皮瓣坏死率及愈合天数与B2组比较,差异有统计学意义(P<0.05)。结论:改良Donati-Allgower缝合法与马黄酊湿敷联合应用可有效预防跟骨骨折术后刀口皮瓣坏死,降低刀口感染等并发症的发生率。

Objective：To analyze the reason for the blade flap necrosis after calcaneal fractures and evaluate the effects of Mahuangding wet packing combined with the improved Donati- Allgower suture in the prevention of flap necrosis complications in calcaneal fractures. Methods：Total 89 patients with calcaneal fractures received the treatment of open reduction,internal fixation and bone graft. There were 22 patients with 22 feet in simple suture group（group A1）,22 patients with 22 feet in simple suture combined with Mahuangding group（group A2）,22 patients with 23 feet in improved Donati- Allgower suture group（group B1） and 23 pa tients with 24 feet in improved Donati- Allgower suture combined with Mahuangding group（group B2）. Results：In the four groups of A1,A2,B1,B2,the foot numbers of flap necrosis were 9,6,5 and 2 feet respectively,the foot numbers of wound infection were 3,1,1,0 feet respectively,the flap necrosis rate was 40.9%,27.3%,21.7% and 4.3% respectively and the average healing time was（15.55±0.35） d,（14.36±0.42） d,（17.35±0.31） d,（16.88±0.21） d respectively. The infection rate,flap necrosis rate and healing time in the group A1,A2 and B1 had statistically difference compared to those in the group B2（P〈0.05）. Conclusion：The Mahuangding wet packing combined with improved Donati- Allgower suture could prevent the postoperative flap necrosis and wound infection effectively in calcaneal fractures.