垂直8字紧密缝合对跟骨骨折术后切口愈合的影响

Influence of vertical figure 8 tight suture on incision healing after calcaneal fracture

[目的]比较垂直8字紧密缝合与Allgower-Donati缝合对跟骨骨折开放复位内固定L切口愈合的影响。[方法]2018年1月—2021年2月,对60例跟骨骨折采用开放复位内固定。其中,31例采用紧密缝合切口(8字组),29例采用Allgower-Donati缝合(AD组)。比较两组早期局部皮肤反应与切口愈合。[结果]8字组切口闭合时间、早期皮肤反应严重程度、早期严重皮肤反应面积显著优于AD组(P<0.05)。随时间推移,两组患者切口局部皮温均无显著变化(P>0.05),相应时间点,两组间局部皮温的差异均无统计学意义(P>0.05)。8字组中,3例切口表皮部分坏死,经换药后延期愈合。AD组中,6例切口裂开,换药4周愈合;3例切口感染,钢板外露,去除钢板、创口换药8周愈合。8字组的切口愈合显著优于AD组(P<0.05)。[结论]垂直8字紧密法缝合跟骨外侧“L”形手术切口,可减少局部不良反应,提高切口愈合率。

[Objective]To compare the healing of L-shaped lateral incision by figure-of-eight vertical tight suture versus Allgower-Donati vertical mattress suture for open reduction internal fixation(ORIF)of calcaneal fractures.[Methods]From January 2018 to February 2021,60 patients received ORIF for Sanders type Ⅲ calcaneal fractures through L-shaped lateral incision.Of them,31 patients had the incision closed by figure-of-eight vertical tight suture(the figure-8 group),while the remaining 29 patients were with traditional Allgower-Donati vertical mattress suture(the AD group).The early local skin reaction and incision healing were compared between the two groups.[Results]The figure-8 group proved significantly superior to the AD group in terms of the incision closure time,the severity of early skin reaction and the area of early severe skin reaction(P<0.05).The incision skin temperature remained unchanged significantly over time in both groups(P>0.05),which were not statistically significantly different between the two groups at any matching time points(P>0.05).In the figure-8 group,3 cases had partial necrosis of the epidermis at the arc site of the incision without infection and dehiscing,which healed delayed by dressing change.In contrast,in AD group,6 cases had incision dehiscing at the"L"shaped corner,which healed after 4 weeks of dressing change,additionally other 3 cases had wound infection with internal fixation exposed,which healed by removal of internal fixation,wound dressing change for 8 weeks.The figure-8 group was significantly superior to the AD group in term of incision healing(P<0.05).[Conclusion]This figure-of-eight vertical tight suture does reduce local adverse reactions and improve incision healing.