“八”字双切口钢板内固定治疗跟骨骨折常见并发症及影响因素分析
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摘要
目的研究"八"字双切口钢板内固定治疗跟骨骨折常见并发症及影响因素。方法回顾性分析2014年2月～2016年2月于内蒙古医科大学第二附属医院接受"八"字双切口钢板内固定治疗的129例跟骨骨折患者的临床资料,所有患者均进行为期2年的随访,分析术后并发症发生情况。并将所有患者按照是否发生并发症分为并发症组47例以及非并发症组82例。比较两组患者的基本资料,并作术后并发症的多因素Logistic回归分析。结果并发症组年龄≥65岁、吸烟、糖尿病、受伤至就诊时间<5 d、手术时间≥1.5 h、未采用克氏针无接触牵拉技术保护软组织以及未放置引流管人数占比相比非并发症组高(均P <0.05)。经多因素Logistic回归分析可得:年龄≥65岁、吸烟、糖尿病、受伤至就诊时间≥5 d、手术时间≥1.5 h、未采用克氏针无接触牵拉技术保护软组织、未放置引流管均是"八"字双切口钢板内固定治疗跟骨骨折术后并发症发生的独立危险因素(均P <0.05)。结论"八"字双切口钢板内固定治疗跟骨骨折常见并发症囊括切口渗液、切口感染以及深静脉血栓等,且较多因素均可能会增加患者术后并发症发生风险,临床应采取科学措施。
Objective To study common complications and influencing factors of "eight-shaped" double incision steel plate internal fixation in the treatment of calcaneal fracture. Methods Clinical data of 129 cases of calcaneal fracture treated with "eight-shaped" double incision steel plate internal fixation in the Second Affiliated Hospital of Inner Mongolia Medical University from February 2014 to February 2016 was retrospectively analyzed. All patients were followed up for 2 years, and the incidence of complications was analyzed. All patients were divided into complications group(47 cases) and non complications group(82 cases) according to whether there were complications. The basic data of the two groups was compared and the multivariate Logistic regression analysis of the postoperative complications was made.Results Complications group had a higher proportion of patient′s age≥65 years, smoking, diabetes mellitus, the time from injury to surgery < 5 d, the operative time≥1.5 h, non-use of Kirschner wire contactless stretch technique to protect soft tissue and non-placement of drainage tube than non-complications group(all P < 0.05). Multivariate Logistic regression analysis showed that age≥65 years, smoking, diabetes mellitus, the time from injury to surgery<5 d, the operative time≥1.5 h, non-use of Kirschner wire contactless stretch technique to protect soft tissue and non-placement of drainage tube were all independent risk factors for complications after "eight-shaped" double incision steel plate internal fixation(all P < 0.05). Conclusion The common complications of "eight-shaped" double incision steel plate internal fixation in the treatment of calcaneal fracture include incision exudation, incision infection and deep venous thrombosis,and many factors may increase the risk of postoperative complications, scientific measures should be taken clinically.
Objective To study common complications and influencing factors of "eight-shaped" double incision steel plate internal fixation in the treatment of calcaneal fracture. Methods Clinical data of 129 cases of calcaneal fracture treated with "eight-shaped" double incision steel plate internal fixation in the Second Affiliated Hospital of Inner Mongolia Medical University from February 2014 to February 2016 was retrospectively analyzed. All patients were followed up for 2 years, and the incidence of complications was analyzed. All patients were divided into complications group(47 cases) and non complications group(82 cases) according to whether there were complications. The basic data of the two groups was compared and the multivariate Logistic regression analysis of the postoperative complications was made.Results Complications group had a higher proportion of patient′s age≥65 years, smoking, diabetes mellitus, the time from injury to surgery < 5 d, the operative time≥1.5 h, non-use of Kirschner wire contactless stretch technique to protect soft tissue and non-placement of drainage tube than non-complications group(all P < 0.05). Multivariate Logistic regression analysis showed that age≥65 years, smoking, diabetes mellitus, the time from injury to surgery<5 d, the operative time≥1.5 h, non-use of Kirschner wire contactless stretch technique to protect soft tissue and non-placement of drainage tube were all independent risk factors for complications after "eight-shaped" double incision steel plate internal fixation(all P < 0.05). Conclusion The common complications of "eight-shaped" double incision steel plate internal fixation in the treatment of calcaneal fracture include incision exudation, incision infection and deep venous thrombosis,and many factors may increase the risk of postoperative complications, scientific measures should be taken clinically.
引文
[1] Zhang Z,Wang Z, Zhang Y,et al. Risk factors for increased postoperative drainage of calcaneal fracturesafter open reduction and internal fixation:an observational study[J]. Medicine(Baltimore),2018,97(32):11818-11819.
[2]江开明,钱军,罗志军,等.跟骨锁定钢板与克氏针张力带治疗髌骨骨折的病例对照研究[J].中国骨伤,2018,31(10):889-893.
[3] JandováS,Pazour J. Limited versus extended lateral approach for osteosynthesis of calcanealfractures-comparison of temporal and dynamic parameters of the gait cycle[J].Acta Chir Orthop Traumatol Cech,2018,85(1):57-61.
[4]覶olak I,覶olak T,Polat MG,et al. The results of physical,radiologic,pedabarographic,and quality-of-life assessments in patients with surgically treated intraarticular calcaneusfractures[J]. J Foot Ankle Surg,2018,57(6):1172-1180.
[5]王琳,马玉林.跟骨骨折的诊断与治疗[C]//第八届足踝外科学术会议论文汇编,2004:127-131.
[6]任栋慧.手术前后高压氧处理对外侧入路切开复位内固定治疗跟骨骨折临床疗效的影响[J].中华航海医学与高气压医学杂志,2018,25(3):188-190.
[7]张勇,杨立峰,庄云强,等.小切口保护跟骨外侧骨瓣可吸收钉治疗跟骨骨折的临床评价[J].中华全科医学,2018,16(4):564-567.
[8] Ni M,Mei J,Li K,et al. The primary stability of different implants for intra-articular calcanealfractures:an in vitro study[J]. Biomed Eng Online,2018,17(1):50.
[9]缪逸鸣,王强,沈影超,等.“八”字双切口钢板内固定治疗跟骨骨折的临床疗效分析[J].中国临床医学,2018,25(1):95-99.
[10] Majeed H, Barrie J, Munro W,et al. Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures:a systematic review of the literature[J].EFORT Open Rev,2018,3(7):418-425.
[11] Tong L,Li M,Li F,et al. A minimally invasive(sinus tarsi)approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children[J]. J Pediatr Orthop B,2018,27(6):556-562.
[12]张洋,朱恒杰,周铮,等.跟骨骨折内固定术后并发症的影响因素分析[J].沈阳医学院学报,2018,20(1):30-31.
[13]黄建平,钱辉,陆飞伟,等.影响跟骨骨折患者术后引流量相关因素研究[J].交通医学,2018,32(3):224-225.
[14] Leite CBG,Macedo RS,Saito GH,et al. Epidemiological study on calcaneus fractures in a tertiary hospital[J].Rev Bras Ortop,2018,53(4):472-476.
[15]崔嵩,张斌,李海涛,等.L形切口治疗闭合性跟骨骨折的术后疗效及影响因素分析[J].医学研究杂志,2017,46(5):39-42.
[16] Lakstein D,Bermant A,Shoihetman E,et al. The posterolateral approach for calcaneal fractures[J]. Indian J Orthop,2018,52(3):239-243.
[17]温晓东,李玉茂,张玉九,等.SandersⅡ、Ⅲ型跟骨骨折术后切口并发症影响因素分析[J].中国骨与关节损伤杂志,2017,32(2):215-217.
[18]潘洪,赵志芳,楼肃亮,等.跟骨骨折切开复位内固定术后创口感染影响因素分析[J].浙江医学,2016,38(23):1946-1948.
[19]徐剑峰,彭五四,曹云.益气温肾汤联合鲑降钙素注射液治疗跟骨骨折术后骨萎缩临床研究[J].国际中医中药杂志,2017,39(4):312-315.
[20]张马军,周铁丽,陈志刚.跟骨骨折术后切口感染的病原菌分布和耐药性及相关原因分析[J].浙江创伤外科,2017,22(4):648-650.
[2]江开明,钱军,罗志军,等.跟骨锁定钢板与克氏针张力带治疗髌骨骨折的病例对照研究[J].中国骨伤,2018,31(10):889-893.
[3] JandováS,Pazour J. Limited versus extended lateral approach for osteosynthesis of calcanealfractures-comparison of temporal and dynamic parameters of the gait cycle[J].Acta Chir Orthop Traumatol Cech,2018,85(1):57-61.
[4]覶olak I,覶olak T,Polat MG,et al. The results of physical,radiologic,pedabarographic,and quality-of-life assessments in patients with surgically treated intraarticular calcaneusfractures[J]. J Foot Ankle Surg,2018,57(6):1172-1180.
[5]王琳,马玉林.跟骨骨折的诊断与治疗[C]//第八届足踝外科学术会议论文汇编,2004:127-131.
[6]任栋慧.手术前后高压氧处理对外侧入路切开复位内固定治疗跟骨骨折临床疗效的影响[J].中华航海医学与高气压医学杂志,2018,25(3):188-190.
[7]张勇,杨立峰,庄云强,等.小切口保护跟骨外侧骨瓣可吸收钉治疗跟骨骨折的临床评价[J].中华全科医学,2018,16(4):564-567.
[8] Ni M,Mei J,Li K,et al. The primary stability of different implants for intra-articular calcanealfractures:an in vitro study[J]. Biomed Eng Online,2018,17(1):50.
[9]缪逸鸣,王强,沈影超,等.“八”字双切口钢板内固定治疗跟骨骨折的临床疗效分析[J].中国临床医学,2018,25(1):95-99.
[10] Majeed H, Barrie J, Munro W,et al. Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures:a systematic review of the literature[J].EFORT Open Rev,2018,3(7):418-425.
[11] Tong L,Li M,Li F,et al. A minimally invasive(sinus tarsi)approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children[J]. J Pediatr Orthop B,2018,27(6):556-562.
[12]张洋,朱恒杰,周铮,等.跟骨骨折内固定术后并发症的影响因素分析[J].沈阳医学院学报,2018,20(1):30-31.
[13]黄建平,钱辉,陆飞伟,等.影响跟骨骨折患者术后引流量相关因素研究[J].交通医学,2018,32(3):224-225.
[14] Leite CBG,Macedo RS,Saito GH,et al. Epidemiological study on calcaneus fractures in a tertiary hospital[J].Rev Bras Ortop,2018,53(4):472-476.
[15]崔嵩,张斌,李海涛,等.L形切口治疗闭合性跟骨骨折的术后疗效及影响因素分析[J].医学研究杂志,2017,46(5):39-42.
[16] Lakstein D,Bermant A,Shoihetman E,et al. The posterolateral approach for calcaneal fractures[J]. Indian J Orthop,2018,52(3):239-243.
[17]温晓东,李玉茂,张玉九,等.SandersⅡ、Ⅲ型跟骨骨折术后切口并发症影响因素分析[J].中国骨与关节损伤杂志,2017,32(2):215-217.
[18]潘洪,赵志芳,楼肃亮,等.跟骨骨折切开复位内固定术后创口感染影响因素分析[J].浙江医学,2016,38(23):1946-1948.
[19]徐剑峰,彭五四,曹云.益气温肾汤联合鲑降钙素注射液治疗跟骨骨折术后骨萎缩临床研究[J].国际中医中药杂志,2017,39(4):312-315.
[20]张马军,周铁丽,陈志刚.跟骨骨折术后切口感染的病原菌分布和耐药性及相关原因分析[J].浙江创伤外科,2017,22(4):648-650.