闭合性跟骨骨折切口并发症的相关因素分析

发布时间：2018-03-08 21:16

  本文选题：跟骨　切入点：骨折　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:跟骨骨折在临床较为常见,多发于中轻年人群,90%为男性,男女发病比例为5.96:1。跟骨骨折术后的并发症发生率较高,包括后足增宽,腓骨长短肌撞击,距下关节僵硬,骨折的畸形愈合,骨折感染,伤口坏死,进行性骨关节病等。其中术后切口并发症,特别是切口的坏死,对医生和患者来说都是灾难性的后果。引起跟骨骨折术后切口并发症发生是多因素造成的,故本研究的目的在于:(1)将可能影响跟骨骨折术后切口并发症的相关因素进行单因素分析,找出与切口并发症发生的相关因素。(2)将相关危险因素进行多因素分析,发现危险因素与切口并发症之间的关系,为临床降低跟骨骨折术后切口并发症发生做出参考。方法:(1)使用回顾性研究的方法,对山西医科大学第二医院骨科第四病区自2012年2月至2014年12月期间116位患者129例的病例资料进行统计分析研究。(2)采用SPSS 17.O统计软件对可能影响跟骨骨折术后切口并发症发生的9个因素进行单因素分析,对有统计学意义的因素再进行多因素Logistic回归分析,以P0.05为差异有统计学意义。结果:129侧跟骨骨折后进行了12-36月(平均18.6个月)的随访,共有16例出现切口并发症:3例(3.1%)钢板外露,5例(2.3%)血肿形成,7例(2.3%)皮缘坏死,1例(0.7%)骨髓炎。单因素分析结果示:吸烟,糖尿病及高血压患者,手术时机,手术时间,牵拉方法,引流方式8个因素与切口并发症的发生相关。多因素Logistic回归分析结果显示:(1)吸烟指数每增加一个等级,并发症的发生风险增加了1.046倍;(2)采用普通引流的并发症发生风险是使用置管冲洗引流的6.847倍;(3)手术时机≤7d的并发症发生风险是手术时机8-14天6.067倍,手术时机14d的并发症发生风险是手术时机8-14天2.079倍;(4)采用静态牵拉方法的并发症发生的风险是采用动态牵拉方法的2.519倍。结论:吸烟指数,手术时机的选择,牵拉方法,引流方式是跟骨切口并发症发生的高危因素。通过禁烟,严格控制血糖,选择恰当的手术时机,术中由经过训练的医师行动态牵拉,使用置管冲洗引流可能有助于减少跟骨骨折术后切口并发症的发生。
[Abstract]:Objective: calcaneal fractures are more common in clinic, 90% of them are males, and the ratio of male to female is 5.96: 1.The incidence of complications after calcaneal fracture is high, including the width of hind foot, the impact of long and short fibula muscle, the stiffness of subtalar joint. Fracture malunion, fracture infection, wound necrosis, progressive osteoarthropathy, etc. Among them, postoperative incision complications, especially incision necrosis, Catastrophic consequences for both doctors and patients. Complications of incision after calcaneal fracture are caused by multiple factors. Therefore, the purpose of this study is to make univariate analysis of the related factors that may affect the postoperative incision complications of calcaneal fractures, and to find out the related factors that are related to the occurrence of incision complications. (2) the related risk factors are analyzed by multivariate analysis. To find out the relationship between risk factors and incision complications, and to provide a reference for clinical reduction of incision complications after calcaneal fracture. Methods A retrospective study was used. The data of 4th cases of 4th patients in Department of Orthopedics of the second Hospital of Shanxi Medical University from February 2012 to December 2014 were analyzed statistically. The results of statistical analysis of 4th patients with calcaneal fracture were analyzed by using SPSS 17.O software. Nine factors of complications were analyzed by univariate analysis. Multivariate Logistic regression analysis was performed on the statistically significant factors, with P0.05 as the significant difference. Results 12 to 36 months (mean 18.6 months) follow-up was performed after the fracture of the calcaneus in 1: 129 sides. A total of 16 cases of incision complications occurred in 3 cases (3.1%) steel plate exposure in 5 cases (2. 3) hematoma formation in 7 cases (2. 3) skin edge necrosis in 1 case (0. 7) osteomyelitis. Univariate analysis showed that: smoking, diabetes mellitus and hypertension, operation timing, operation time, traction method. The multivariate Logistic regression analysis showed that the smoking index increased by one grade. The risk of complications was increased by 1.046 times / 2) the risk of complications with common drainage was 6.847 times of that of using tube irrigation and drainage, and the risk of complications with operation time 鈮，

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