影响跟骨闭合性骨折术后愈合和皮瓣坏死的因素分析

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摘要目的分析导致跟骨闭合性骨折术后切口愈合缓慢和皮瓣坏死的风险因素，为跟骨闭合性骨折术后软组织并发症的防治提供参考依据。方法选取张家港市中医医院及苏州大学附属第一医院2011年3月至2016年3月收治的402例跟骨闭合性骨折患者，按照其术后软组织并发症发生情况进行分组，计算患者术后软组织并发症发生率，比较两组患者临床资料的差异，将存在统计学差异的因素纳入Logistic多因素回归分析，总结导致跟骨闭合性骨折术后切口愈合缓慢和皮瓣坏死的风险因素。结果患者发生术后软组织并发症发生率为12.44％。多因素回归分析显示，合并糖尿病、钢板内固定是导致跟骨闭合性骨折术后切口愈合缓慢和皮瓣坏死的风险因素，动态牵拉、自体髂骨植骨为保护因素(P＜0.05)。结论跟骨闭合性骨折术后软组织并发症的发生与患者自身状态、手术操作方案均具有密切关联，应重视患者血糖水平的调节及术中操作的科学性。

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关键词 ：跟骨闭合性骨折, 切口愈合缓慢, 皮瓣坏死, 软组织并发症, 风险因素

Abstract：Objective To analyze the risk factors of slow incision healing and flap necrosis after the operation of closed calcaneal fracture，and to provide some references for the prevention and treatment of soft tissue complications after the operation of closed calcaneal fracture.Methods 402 patients with closed calcaneal fracture from March 2011 to March 2016 in the Traditional Chinese Medicine Hospital of Zhangjiagang and First Hospital Affiliated to Soochow University were selected and divided into two groups according to the occurrence of the soft tissue complications，including the patients with slow incision healing and flap necrosis as the occurrence group，and the patients without slow incision healing and flap necrosis as the nonoccurrence group. The incidence of soft tissue complications and clinical data between the two groups were compared，the factors with statistical difference were involved in the Logistic regression analysis，and the risk factors of slow incision healing and flap necrosis after the operation of closed calcaneal fracture were summarized. Results 50 of 402 patients were observed the soft tissue complications，the incidence rate was 12.44％，29 cases (58.00％) with slow incision healing，and 21 patients (42.00％) with flap necrosis. Multivariate analysis showed that diabetes and steel plate internal fixation were risk factors for slow incision healing and flap necrosis，and dynamic traction and autogenous iliac bone graft were protective factors (P＜0.05).Conclusion The incidence of soft tissue complications after the operation of closed calcaneal fracture is closely related to the physical status and the operation scheme. The adjustment of blood glucose level and the scientific operation should be paid more attention.

Key words： closed calcaneal fracture incision healing flap necrosis soft tissue complications risk factor

作者简介: 季科(1981－)，男，主治医师，张家港市中医医院，215600。

引用本文:

季科 1，王素春 1，李丹勇 1，徐世平 1，芮碧宇 2，张洪涛 3. 影响跟骨闭合性骨折术后愈合和皮瓣坏死的因素分析[J]. 实用骨科杂志, 2017, 23(4): 309-311.
Ji Ke，Wang Suchun，Li Danyong，et al. Analysis of the Risk Factors of Slow Incision Healing and Flap Necrosis after the Operation of Closed Calcaneal Fracture. sygkzz, 2017, 23(4): 309-311.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I4/309

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