负压封闭引流预防跟骨骨折术后切口并发症的疗效观察

发布时间：2018-05-03 19:11

本文选题：负压封闭引流 + 跟骨骨折　；参考：《山东大学》2015年硕士论文

【摘要】：背景跟骨骨折在足部骨折中比较常见,跗骨骨折中约有60%为跟骨骨折。跟骨骨折多由高能量损伤所致,以高处坠落,足跟受到撞击最常见。跟骨骨折损伤机制复杂,分类方法较多,治疗方式不统一,最常用的还是手术治疗。但是由于跟骨及其周围组织解剖结构复杂,软组织覆盖差等原因,术后出现切口裂开、坏死、感染的概率较大,甚至导致创伤性关节炎。负压封闭引流技术(VSD)于1992年开始出现,现在已经成为一种处理难愈合伤口的标准治疗方法。与其他引流技术相比,负压封闭引流技术能够进行高效、全方位的引流。它不仅能够将血液、渗出液和坏死组织引流出体外,还能填塞于创面空腔,促进感染腔隙的闭合。目前,负压封闭引流技术已经被广泛应用于复杂软组织损伤、开放性骨折等方面,但是在预防手术切口并发症方面,尚未有太多的报道。目的探讨用负压封闭引流预防跟骨骨折切开复位内固定术后切口并发症的临床疗效。方法从山东大学第二医院骨外科于2012年5月至2014年12月期间治疗的跟骨骨折患者中选取病历资料较完善的73例81足进行回顾性分析。选取的患者均诊断为跟骨闭合性骨折,属于跟骨Sanders分类中的Ⅱ型～Ⅲ型,给予行骨折切开复位内固定术,手术均采用跟骨外侧“L"形切口切开复位,骨质缺损者取自体髂骨或人工骨植入,使用跟骨钛钢板及螺钉固定,2-0丝线逐层缝合至皮肤。将患者按照引流方式的不同分为负压封闭引流组、自制负压引流组和橡皮条引流组：负压封闭引流组11例13足,术后给予切口负压封闭引流；自制负压引流组27例29足,术后以纱布垫自制负压引流；橡皮条引流组35例39足,术后给予切口橡皮条引流,常规换药。通过比较三组患者术后切口引流时间、切口愈合时间、切口并发症发生情况,评价预防性使用负压封闭引流对跟骨骨折术后切口并发症的临床疗效。结果在切口引流时间方面,负压封闭引流组为5(4,5)天,自制负压引流组为5(4,5)天,橡皮条引流组为2(2,2)天。引流方式对术后切口引流时间的影响有统计学差异(H=66.703,p=0.000)。组内多重比较：负压封闭引流组与自制负压引流组的引流时间差异无统计学意义(H=2.589,p=1.000),而橡皮条引流组与该两组的引流时间差异均有统计学意义(H=42.090,p=0.000；H=39.501,p=0.000)。在切口愈合时间方面,负压封闭引流组为16(14,16)天,自制负压引流组为15(15,18)天,橡皮条引流组为18(15,24)天。引流方式对术后切口愈合时间的影响有统计学差异(H=8.622,p=0.013)。组内多重比较：负压封闭引流组与自制负压引流组的切口愈合时间差异无统计学意义(H=-4.438,p=1.000),与橡皮条引流组的切口愈合时间差异有统计学意义(H=-17.949,p=0.048),自制负压引流组与橡皮条引流组的切口愈合时间差异无统计学意义(H=-13.511,p=0.053)。在术后切口并发症方面,负压封闭引流组出现1例切口边缘少量发黑坏死,切口并发症发生率为7.69%。自制负压引流组出现2例切口皮缘发黑坏死,1例切口愈合不良,切口并发症的发生率为10.34%。橡皮条引流组中有8例出现有切口部分皮缘坏死、切口裂开,3例切口脂肪液化坏死,切口感染不愈合,切口并发症的发生率为28.21%。引流方式对术后切口并发症发生率的影响有统计学差异(χ2=6.591,p=0.031)。负压封闭引流组与自制负压引流组的并发症发生率差异无统计学意义(χ2=0,459,p=1.000),而橡皮条引流组与该两组的并发症发生率差异均有统计学意义(χ2=10.686,p=0.013)。结论跟骨骨折切开复位内固定术后,应用负压封闭引流可延长引流时间,明显降低切口并发症的发生率,但是对于缩短切口愈合时间的作用尚不确切,仍需进一步研究。自制负压引流是对负压封闭引流的一种模拟方式,对于经济条件较差的患者,不失为一个良好的选择。
[Abstract]:Background calcaneal fractures are common in foot fractures. About 60% of the tarsal fractures are calcaneus fractures. Calcaneus fractures are mostly caused by high energy damage. The heel is the most common cause of the calcaneus fracture. The heel is the most common one. The mechanism of calcaneus fracture is complicated, the methods of classification are many, the treatment is not uniform, and the most commonly used surgical treatment. But the calcaneus and the calcaneus are the most common. The complicated anatomical structure around the tissue, the poor soft tissue coverage and so on, the postoperative incision split, necrosis, the probability of infection and even traumatic arthritis. Negative pressure closed drainage (VSD) began to appear in 1992, and now it has become a standard treatment for the treatment of difficult wound. Compared with other drainage techniques, it is negative. Pressure closed drainage technology can carry out high efficiency and omni-directional drainage. It can not only drain the blood, exudate and necrotic tissue in vitro, but also fill the cavity of the wound and promote the closure of the infection lacunae. There are not much reports on the complications of surgical incision. Objective to explore the clinical efficacy of negative pressure closed drainage in the prevention of postoperative complications after open reduction and internal fixation of calcaneal fracture. Methods from the second hospital of Shandong University in May 2012 to December 2014, the medical records of the patients with bone fracture were selected. 73 cases of 81 feet were analyzed retrospectively. All the patients were diagnosed as closed fracture of calcaneus, belonging to type II to III in the Sanders classification of calcaneus, open reduction and internal fixation for fracture, open reduction and reduction of the lateral "L" incision in the calcaneus. The bone defect was taken from the body iliac bone or artificial bone, and the titanium plate and screw were used. The 2-0 silk thread was sutured to the skin layer by layer. The patients were divided into negative pressure closed drainage group according to the different drainage methods, the self-made negative pressure drainage group and the rubber strip Drainage Group: 11 cases 13 feet in the negative pressure closed drainage group, the incision negative pressure closed drainage after the operation; the self-made negative pressure drainage group 27 cases 29 feet, after the operation, the self-made negative pressure drainage with gauze pad; rubber skin after operation; rubber skin. There were 35 cases of 39 feet in the drainage group. The incision drainage time was given after the operation and the conventional dressing was given. By comparing the drainage time of the incision, the healing time of the incision and the complication of the incision in the three groups, the clinical effect of the negative pressure closed drainage on the postoperative complications of the calcaneal fracture was evaluated. The closed drainage group was 5 (4,5) days, the self-made negative pressure drainage group was 5 (4,5) days and the rubber strip drainage group was 2 (2,2) days. The effect of drainage method on the postoperative incision drainage time was statistically different (H=66.703, p=0.000). There was no significant difference in the drainage time between the negative pressure closed drainage group and the self-made negative pressure drainage group (H=2.589, p=1.000). The difference of drainage time between the rubber strip drainage group and the two groups was statistically significant (H=42.090, p=0.000; H=39.501, p=0.000). In the healing time of the incision, the negative pressure closed drainage group was 16 (14,16) days, the self-made negative pressure drainage group was 15 (15,18) days, and the rubber strip was 18 (15,24) days. The effect of drainage on the healing time of postoperative incision was affected. There were statistical differences (H=8.622, p=0.013). There was no significant difference in the healing time between the negative pressure closed drainage group and the self-made negative pressure drainage group (H=-4.438, p=1.000), and the difference between the incision healing time of the drainage group and the rubber strip drainage group was statistically significant (H= -17.949, p=0.048), the self-made negative pressure drainage group and the rubber strip drainage group. There was no significant difference in the time of incision healing (H=-13.511, p=0.053). In the postoperative incision complication, 1 cases had a small amount of black necrosis on the edge of the incision, the incidence of incision complication was 2 cases of skin margin and necrosis of incision in the self-made negative pressure drainage group of 7.69%., 1 cases of incisional wound healing, and the incidence of incision complications was 10. In the.34%. rubber strip drainage group, there were 8 cases of skin necrosis of incision, incision split, 3 cases of fat liquefaction and necrosis of incisional incision, nonunion of incision infection, and the incidence of incision complications was the effect of 28.21%. drainage on the incidence of postoperative incision complications (x 2= 6.591, p=0.031). Negative pressure closed drainage group and self-made negative pressure injection were used. There was no significant difference in the incidence of complications in the flow group (x 2=0459, p=1.000), but there was significant difference in the incidence of complications between the rubber strip drainage group and the two groups (x 2=10.686, p=0.013). Conclusion after open reduction and internal fixation of calcaneal fracture, the application of negative pressure closure can prolong the drainage time and obviously reduce the incidence of complications of incision. The rate of birth, but the effect of shortening the healing time of the incision is still uncertain, still needs further study. Self-made negative pressure drainage is a simulation of negative pressure closed drainage, which is a good choice for patients with poor economic conditions.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】