闭合性跟骨骨折内固定术后切口处皮肤坏死的影响因素及其预防

Influence factors of skin necrosis at incision after internal fixation for closed calcaneal fracture and their prevention

目的探讨闭合性跟骨骨折内固定术后切口处皮肤坏死的相关影响因素,并提出预防对策。方法回顾性分析2012年9月-2018年5月行内固定手术治疗的132例闭合性跟骨骨折患者的临床病例资料,根据术后是否出现切口处皮肤坏死情况将其分为坏死组与未坏死组,并采用单因素χ2检验及多因素Logistic回归分析法分析影响闭合性跟骨骨折内固定术后切口处皮肤坏死的相关危险因素,且提出预防对策。结果132例中,有22例(16.67%)术后出现切口处皮肤坏死;在年龄≥60岁、有糖尿病、有高血压、有吸烟史、L型切口位置偏上、L型切口拐角处角度≤90°、术中止血带使用时间≥90 min、手术时间≥120 min、术后弹力绷带包扎时间≥3 d、术后创面处于潮湿环境的构成比等方面,坏死组均明显高于未坏死组(P<0.05),且经Logistic回归分析发现其均是闭合性跟骨骨折内固定术后切口处皮肤坏死的危险因素(OR=4.872、5.347、4.865、4.131、3.544、2.876、3.005、2.749、5.193、5.256,P<0.01或0.05)。结论老年、糖尿病、高血压、吸烟史、切口位置偏上、L型切口拐角处角度≤90°、术中止血带使用时间及手术时间过长、术后加压包扎时间过长及术后切面潮湿均是闭合性跟骨骨折内固定术后切口处皮肤坏死的危险因素,临床工作中需积极给予针对性预防措施,以促进结局改善。

Objective To explore the related factors of skin necrosis at incision after internal fixation for closed calcaneal fracture and put forward preventive measures.Methods The clinical data of 132 cases with closed calcaneal fracture treated with internal fixation from September 2012 to May 2018 were retrospectively analyzed.They were divided into the Necrotic Group and Non-Necrotic Group according to whether there is skin necrosis at incision after operation.Single factorχ2 test and multiple factor Logistic regression analysis were used to analyze relevant risk factors of skin necrosis at incision after internal fixation for closed calcaneal fracture,and the preventive measures were put forward.Results Among 132 cases,there were 22 cases(16.67%)with skin necrosis at incision after operation.The Necrotic Group was significantly higher than the Non-Necrotic Group in terms of the proportion of cases with age≥60 years old,diabetes,hypertension,smoking history,L-shaped incision position above average,L-shaped incision angle≤90°,intraoperative duration of tourniquet use≥90 min,operation duration≥120 min,postoperative duration of elastic bandage use≥3 d and wound surface in moist environment after operation(P<0.05).Logistic regression analysis showed that all above were risk factors for skin necrosis after internal fixation for closed calcaneal fractures(OR=4.872,5.347,4.865,4.131,3.544,2.876,3.005,2.749,5.193,and 5.256,P<0.01 or 0.05).Conclusion The elderly,diabetes,hypertension,smoking history,L-shaped incision position above average,L-shaped incision angle≤90°,intraoperative duration of tourniquet use≥90 min,operation duration≥120 min,postoperative duration of elastic bandage use≥3 d and postoperative moist wound surface are risk factors for skin necrosis at incision after internal fixation for closed calcaneal fracture.Targeted preventive measures should be given in clinical practice to improve the outcome.