摘要
目的探讨经外侧扩大"L"形切口切开复位内固定治疗闭合性跟骨骨折术后切口并发症的危险因素。方法采用病例对照研究分析2019年1月至2022年1月厦门大学附属福州市第二医院收治的128例(139足)经外侧扩大"L"形切口行切开复位内固定的闭合性跟骨骨折患者临床资料,其中男113例(123足),女15例(16足);年龄24~79岁[(48.2±10.8)岁]。单侧117例,双侧11例。根据骨折线Sanders分型:Ⅰ型3足,Ⅱ型92足,Ⅲ型40足,Ⅳ型4足。根据术后切口并发症发生情况,将患者分为并发症组(33足)和对照组(106足)。记录两组性别、年龄、侧别、骨折分型、合并骨折、糖尿病史、吸烟史、局部水疱、术前等待时间、植骨、引流、手术时间、止血带使用时间、预防性使用抗生素次数、术后改善微循环治疗、术前及术后实验室指标(白细胞计数、血红蛋白、白蛋白)等资料。采用单因素分析上述指标与术后切口并发症的相关性,并采用多因素Logistic回归分析确定独立危险因素。结果单因素分析结果显示,糖尿病史、吸烟史、预防性使用抗生素次数、术后改善微循环治疗、术后白蛋白、术后血红蛋白与术后切口并发症有一定的相关性(P均<0.05);性别、年龄、侧别、骨折分型、合并骨折、局部水疱、术前等待时间、植骨、引流、手术时间、止血带使用时间、术前白细胞计数、术前白蛋白、术前血红蛋白、术后白细胞计数与术后切口并发症不相关(P均>0.05)。多因素Logistic回归分析结果表明,糖尿病史(OR=3.51,95%CI 1.29~9.50,P<0.05)、吸烟史(OR=3.53,95%CI 1.34~9.30,P<0.05)、预防性使用抗生素<2次(OR=2.52,95%CI 1.04~6.10,P<0.05)及术后未进行改善微循环治疗(OR=2.97,95%CI 1.79~12.45,P<0.05)与术后切口并发症显著相关(P<0.05)。结论糖尿病史、吸烟史、预防性使用抗生素<2次、术后未进行改善微循环治疗是闭合性跟骨骨折行外侧扩大"L"形切口切开复位内固定术后发生切口并发症的独立危险因素。
Objective To investigate the risk factors for incision complications in open reduction and internal fixation of closed calcaneal fracture via an enlarged lateral L-shaped incision.Methods A case-control study was used to analyze the clinical data of 128 patients(139 feet)with closed calcaneal fracture treated by open reduction and internal fixation via an enlarged lateral L-shaped incision in Fuzhou Second Hospital affiliated to Xiamen University from January 2019 to January 2022,including 113 males(123 feet)and 15 females(16 feet);aged 24-79 years[(48.2±10.8)years].The fracture was on the one side in 117 patients and on both sides in 11 patients.According to Sanders classification,type I was noted in 3 feet,type II in 92,type III in 40,and type IV in 4.All patients were treated with an enlarged lateral L-shaped shaped incision for open reduction and internal fixation.The patients were divided into complication group(33 feet)and control group(106 feet),according to the occurrence of postoperative incisional complications.Data were recorded in both groups,including gender,age,side,fracture subtype,combined fractures,diabetes history,smoking history,local blistering,preoperative waiting time,bone graft,drainage,operative time,time of tourniquet use,number of prophylactic antibiotic use,postoperative treatment to improve microcirculation and preoperative and postoperative laboratory indices(white blood cell count,haemoglobin and albumin).The correlation between the above data and postoperative incisional complications was analyzed using the univariate analysis,followed by identification of independent risk factors by the multi-factor Logistic regression analysis.Results Univariate analysis showed that diabetes history,smoking history,number of prophylactic antibiotic use,postoperative treatment to improve microcirculation,postoperative albumin and postoperative haemoglobin were associated with postoperative incisional complications(all P<0.05).On the contrary,gender,age,side,fracture subtype,combined fractures,local blistering,preoperative waiting time,bone graft,drainage,operative time,time of tourniquet use,preoperative white blood cell count,preoperative albumin,preoperative haemoglobin and postoperative white blood cell count were not associated with postoperative incisional complications(all P>0.05).Multi-factor Logistic regression analysis showed that diabetes history(OR=3.51,95%CI 1.29-9.50,P<0.05),smoking history(OR=3.53,95%CI 1.34-9.30,P<0.05),prophylactic antibiotic use<2 times(OR=2.52,95%CI 1.04-6.10,P<0.05)and lack of postoperative treatment to improve microcirculation(OR=2.97,95%CI 1.79-12.45,P<0.05)were significantly associated with postoperative incisional complications(P<0.05).Conclusion Diabetes history,smoking history,prophylactic antibiotic use<2 times and lack of postoperative treatment to improve microcirculation are independent risk factors for incisional complications in open reduction and internal fixation of closed calcaneal fracture via a lateral enlarged L-shaped shaped incision.
作者
陈宾
郑科
黄涛
陈培生
林朝晖
林东泽
林凤飞
Chen Bin;Zheng Ke;Huang Tao;Chen Peisheng;Lin Chaohui;Lin Dongze;Lin Fengfei(Department of Orthopedics,Fuzhou Second Hospital Affiliated to Xiamen University,Third Clinical Medical College of Fujian Medical University,Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopedic Trauma,Fuzhou Trauma Medical Center,Fuzhou 350007,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第9期814-820,共7页
Chinese Journal of Trauma
基金
福建省自然科学基金(2020J011186,2021J011315)
福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014)
福州市卫生健康科技计划(2019-S-wp3,2021-S-wq12)
福州市创伤医学中心项目(2018080303)
福州市科技计划(2020-WS-87)。
关键词
跟骨
骨折
闭合性
手术后并发症
外科伤口
危险因素
Calcaneus
Fractures,closed
Postoperative complications
Surgical wound
Risk factors
作者简介
通信作者:林凤飞,Email:596558644@qq.com,电话:13905929749。
