跟骨骨折内固定术后切口缘皮瓣坏死可能原因及处理.docVIP

跟骨骨折内固定术后切口缘皮瓣坏死可能原因及处理【摘要】 目的 探讨跟骨骨折切开复位内固定术后切口缘皮瓣坏死的可能原因及治疗方法。方法 分析42例跟骨骨折切开复位内固定术治疗后发生术后切口缘皮瓣坏死的8例患者的与切口缘皮瓣坏死相关的可能原因及其治疗情况。结果 8例切口皮缘坏死，坏死率为19.05%，坏死部位均为以L形拐角的近端为顶点的两端，局部解剖及伤情因素仍是造成皮瓣坏死的主要因素。结论 注重围手术期的处理及规范手术操作，可以降低皮缘坏死率。 【关键词】 跟骨;骨折;骨折固定术;内外科皮瓣;坏死 Possible Causes of flap margin necrosis resulted from internal fixation for calcaneal fractures and management LUO Wei, CHENG Ming-hua, XIAO Xun-gang. Department of Orthopaedics, the first people’s Hospital of chengzhou, chengzhou,Hunan, 423000,China 【Abstract】 Objective To explore possible causes of flap margin necrosis resulted from internal fixation for calcaneal fractures and management of the flap margin necrosis. Methods Forty two patients with calcaneal fractures had been treated by open reduction and internal fixation between Aug.2005 and Nov.2010. Eight cases out of the forty two patients had suffered from flap margin necrosis. The possible causes and management of flap margin necrosis had been analyzed. Results Out of the 42 patients, 8 cases had suffered from marginal necrosis of skin incision, accounting for 19.05%. The proximal top site of L-shaped turning was the location of necrosis. Regional anatomy and the status and the degree of injury were the main causes of flap necrosis. Conclusion Standardizing perioperative management and undergoing delicate surgical procedures may reduce the occurrence of skin flap necrosis. 【Key words】 Calcaneus; Fractures; Fracture fixation; Surgical flap; Necrosis 跟骨骨折是关节内骨折，致残率较高［1］，跟骨骨折的发生率有逐年增高趋势。近年来手术内固定方法在临床应用较为广泛，手术降低致残率的同时手术所引起的并发症问题也逐渐受到关注，其中切口的皮缘坏死则是跟骨骨折中较为常见的术后并发症［2］，这就使得探讨皮缘坏死的可能原因，从而据此采取相应的预防处理措施显得尤其必要。本研究就2005年8月至2010年11月对42例跟骨骨折sanders2、3、4型患者进行手术内固定治疗的皮缘坏死情况进行分析和总结，现将结果报道如下。 1 资料与方法 1.1 一般资料 42例跟骨骨折中，男30例，女12例，年龄18～56岁，按照sanders CT分类，2型16例，3型24例，4型2例，致伤原因均为高处坠落伤，骨折均为闭合性，皮肤出现张力性水泡12例。 1.2 术前准备及治疗 所有患者均给予消肿治疗，视肿胀情况给予患肢抬高，加压包扎，伤后72 h内给予冷敷，72 h后给予热敷，静脉滴注20%甘露醇250 ml，β-七叶皂甙钠20 mg，1次/d,3 d。12例出现张力性水泡者局部碘伏消毒后用无菌12号针头刺破排除积液，局部换药并全身应用抗生素预防感染。手术时机