跟骨骨折内固定术后切口皮肤坏死原因及预防措施临床分析

Clinical analysis of causes and preventive measures of incision skin necrosis after internal fixation of calcaneal fracture

目的探讨跟骨骨折切开复位内固定术后切口皮肤坏死的原因及防范措施。方法70例(76侧)跟骨关节内移位骨折患者作为研究对象,其中30例(31侧)跟骨骨折采用传统大L形切口手术治疗患者作为前期组,40例(45侧)跟骨骨折采用改良L形切口手术治疗患者作为后期组。统计分析两组不同切口术后皮肤坏死情况及原因。结果后期组皮肤坏死率(8.89%)及切口感染率(6.67%)显著低于前期组(29.03%、16.13%),差异有统计学意义(P<0.05)。结论传统大L形切口可能人为损伤了跟骨外侧皮瓣血供,是引发切口皮肤坏死的主要原因;改良L形切口保护了局部皮肤血供,有效降低皮肤坏死率。SandersⅣ型骨折、局部皮肤挫损严重、术后引流不畅、伤口感染以及换药不及时等,均可引发或加重皮肤坏死和感染。

Objective To discuss the causes and preventive measures of incision skin necrosis afterinternal fixation of calcaneal fracture. Methods There were 70 cases (76 sides) of intra-articular displaced calcaneal fracturesas study subjects, of which 30 cases (31 sides) of calcaneal fractures were treated withtraditional large L-shaped incision as the early group, 40 cases (45 sides) of calcaneal fractures were treated withmodified L-shaped incision as the late group. The status and causes of skin necrosis after different incisions intwo groups was analyzed. Results The later group had significantly lower skin necrosis rate (8.89%) and incisioninfection rate (6.67%) than early group (29.03% and 16.13%). Their difference was statistically significant (P<0.05).Conclusion The traditional large L-shaped incision may artificially damage the blood supply of the lateralcalcaneal flap, which is the main cause of skin necrosis. The modified L-shaped incision protects the local skinblood supply and effectively reduces the skin necrosis rate. Sanders type IV fracture, severe local skin contusion,poor drainage, wound infection and improper dressing change can cause or aggravate skin necrosis and infection.