跟骨骨折内固定术后切口并发症的临床分析.docx

跟骨骨折内固定术后切口并发症的临床分析[摘要]目的分析跟骨关节内骨折术后切口皮瓣坏死等并发症的原因探讨避免跟骨术后切口皮瓣愈合不良的策略。方法2010年3月―2014年11月该院共收治跟骨骨折患者53例均行切开复位钢板内固定术。手术时间7～14d均采取跟骨外侧入路跟骨解剖钛板固定术后12号硅胶引流管经足背戳孔置入并负压引流切口无需弹力绷带加压包扎。结果1例患者术后出现切口并发症为切口皮瓣坏死发病率为1.9%。经清创换药后皮肤缺损并内固定物外露再次手术行腓肠神经逆行岛状皮瓣闭合创面。结论选择合适手术时间窗、手术操作规范轻柔、充分引流是有效减少切口并发症的关键。[关键词]跟骨骨折；手术方法；切口并发症[中图分类号]R276.7[文献标识码]A[文章编号]1674-0742（2016）01（a）-0042-03ClinicalAnalysisoftheWoundComplicationsafterCalcanealFracturewithInternalFixationGUWeiDepartmentofOrthopedicsChineseMedicineHospitalofQijiangDistrictChongqingChongqing401420China[Abstract]ObjectiveToanalyzethecausesofincisionskinflapnecrosisafterintra-articularcalcanealfracturesurgeryandexplorethemeasuresforimprovingthehealingofincisionskinflapaftercalcanealfracturesurgery.MethodsAtotalof53caseswithcalcanealfractureadmittedinourdepartmentfromMarch2010toNovember2014weregivenopenreductionandinternalfixationwithplate.Timingofsurgery7-14days.AllthepatientsweretreatedbylateralapproachtocalcaneusandtitaniumplatefixationpostoperativenegativepressuredrainageviatheNo.12siliconedrainagetubeinsertedinthedorsalpunctureandtheincisionwithoutelasticbandage.ResultsThecomplicationsuchasincisionskinflapnecrosisoccurredin1caseaftersurgerywiththeincidencewas1.9%.Afterdebridementanddressingtheskinappeareddefectandtheinternalfixatorexposedbutthewoundwasclosedafterthesecondsurgeryofsuralnervereverseislandskinflaprepairing.ConclusionTheappropriatetimeforoperationgentlesurgicalpracticesandadequatedrainagearethekeytoreducingthewoundcomplications.[Keywords]Calcanealfracture；Surgicalmethod；Woundcomplications跟骨关节内骨折十分常见占跟骨骨折的70%伤者多为青壮年严重损伤时易致残。对于跟骨关节内骨折公认经足跟外侧“L”形切口入路可以获得距下关节面的良好显露直视下容易将跟骨关节内骨折解剖复位坚强内固定早期功能锻炼患者预后一般均较好。因跟骨形态不规则解剖结构复杂对医师技术要求较高若医师对跟骨骨折缺乏正确的认识未形成一套完整的规范的治疗方案患者术后极可能发