跟骨骨折术后切口愈合不良原因分析及对策

Analysis and management of faulty incision union for post-operation of calcaneal fracture

目的探讨跟骨骨折术后切口愈合不良的原因,寻求预防切口愈合不良的措施。方法分析2004年11月~2012年5月本科采用切开复位钢板内固定术治疗的102例跟骨骨折,术后切口愈合不良11例,占随访病例的10.8%,其中皮缘小范围坏死7例、皮缘部分坏死伴浅表感染1例,钢板部分外露3例;对愈合不良病例进行回顾性疗效分析,寻求预防切口愈合不良的措施。结果经过换药等治疗后,9例切口瘢痕愈合,1例钢板外露伴感染经过换药后采用拆除内固定钢板,再经换药,创面愈合,1例行皮瓣转移覆盖创面后痊愈。结论为防止手术切口愈合不良,需要注意手术时机,掌握手术技巧,正规操作,防止血运进一步破坏,预防切口感染,纠正全身不良情况,提高机体抗手术打击能力,是可以有效减少切口愈合不良的发生的。

Objective To investigate the causes of faulty incision and to present preventive measures for post-operation of calcaneal frature.Mathods Open reduction and internal fixation was performed on 102 cases of calcaneal fracture.There were 11 cases indentified as faulty incision union(10.8%),in which 7 cases were limited necrosis of the incision edges,and 1 cases was necrosis of incision edges with subcutaneous infection,and 3 cases were exposed implant.We had a retrospective anglysis for the 11 cases and present the preventive measures.Results 9 cases form the 11 cases were healed with cicatrix after general wound care,1 case with exposed implant as well as infection was healed after removed the implant,1 case was healed by local skin flap transfer operation.Conclusion To prevent faulty incision union for post-operation of calcaneal fracture,the operative timing must be consided,the surgeons must have a skilled operative technique and protect the incison blood vessels carefully as well as improve the patient health conditions and prevent incision infection.