应用气压足底泵治疗闭合性跟骨骨折周围软组织肿胀治疗效果的临床观察
发布时间：2018-09-18 14:35
【摘要】：目的:跟骨骨折的形成往往是由于高能量的损伤所导致,如从高处坠落(梯子、屋顶、树以及窗台等)和在机动车交通事故中(当机动车正面碰撞时油门踏板或制动踏板的冲击力撞击足底导致骨折等)等,此外还包括踝部的扭伤以及不当的着陆(如滑雪运动员、攀岩爱好者及杂技演员等),在跟骨发生骨折后由于暴力可以通过肢体传导的因素,患者通常可能还会合并脊柱胸腰段的压缩性骨折,股骨颈骨折、髋臼骨折以及胫骨平台骨折或韧带损伤等并发症状。跟骨骨折的患者常常需要进行手术治疗,关节面移位不明显的患者一般行撬拨复位术治疗,而关节面严重塌陷并明显移位的患者常需行切开复位内固定术,但因为跟骨周围毗邻的软组织较为薄弱,局部软组织在高能量创伤后通常会严重肿胀,在实际临床工作当中为避免术后伤口裂开、感染等并发症状的出现,经常需要将手术延迟,一般需要8~19天,最长多达2~3周。本研究通过观察记录应用气压足底泵治疗闭合性跟骨骨折术前周围软组织肿胀的情况,分析评价应用气压足底泵治疗术前闭合性跟骨骨折周围软组织肿胀临床疗效,为临床治疗工作提供参考依据。方法:收集自2013年1月至2015年1月河北医科大学第三医院收治的15例新鲜跟骨骨折(骨折分型为Sanders IIIAB、IIIAC、IIIBC及IV)且行切开复位内固定术的患者为研究对象,将患者分为A B两组,入院当天即开始治疗,A组患者应用气压足底泵进行物理按摩治疗,4次/日,1h/次,此组为实验组;B组患者采用传统抬高患肢,利用重力因素消肿治疗,此组为实验组。两种术前软组织消肿方法:1.应用气压足底泵对伤肢进行物理按摩治疗(实验组),4次/日,1小时/次。2.采用传统抬高制动患肢(对照组),利用重力因素进行消肿治疗。手术治疗方式:临床消肿疗效的判定标准及术后伤口记录标准:分别于两组患者入院后每日检查患者伤足肿胀情况,直至伤足足跟部外侧软组织出现较为明显的皮纹征,即皱褶实验阳性,记录患者从创伤骨折后直至手术当日的时间区间,比较两组间时间区间的差别并进行统计学分析,同时记录两组患者术后伤口的愈合情况,伤口轻度渗出、发红为表浅感染;伤口裂开同时伴脓性分泌物为深部感染。手术治疗方式:AB两组患者均采用跟骨外侧手术入路方式,手术切口始于患足外踝上1.5 cm处,沿外踝后缘与跟腱前缘中点向下到达足背外侧皮肤与跖骨皮肤的交界处,然后再转向水平方向切至第五跖骨基底外侧部,呈单一“L”型切口,随后将跟骨外侧区覆盖皮瓣全部掀起,腓骨肌向上方牵开,充分暴露跟骨外侧区域术野,采用No-touch技术,直视下复位骨折断端,最终置入跟骨重建钢板固定。结果:应用气压足底泵进行术前消肿治疗的患者至术日当天历时4~6天,平均5.44±0.73天,应用传统抬高患肢方法进行术前消肿的患者至术日历时4~10天平均7.83±2.04天,经统计学分析后,两组间时间差异具有统计学意义(P0.05);试验过程中A组中有1例患者术后伤口为表浅感染,经分泌物培养+药敏试验后诊断为金黄色葡萄球菌感染,对万古霉素敏感;B组中有1例患者术后伤后为表浅感染,经分泌物培养+药敏试验后诊断为鲍曼不动杆菌,对头孢哌酮舒巴坦敏感,2例患者经静脉滴注敏感抗生素、伤口局部理疗后,伤口愈合良好,均无深部感染的出现。结论:应用气压足底泵治疗术前跟骨闭合性骨折软组织肿胀,具有安全可靠,快速消肿、简化治疗过程、提前手术时机且术后伤口并发症较少等优点,是一种较好治疗软组织肿胀的方法。
[Abstract]:OBJECTIVE: Fractures of the calcaneus are often caused by high-energy injuries, such as falling from high places (ladders, roofs, trees, windowsills, etc.) and in motor vehicle accidents (when a motor vehicle crashes frontally, the impact of the accelerator pedal or the brake pedal hits the sole of the foot, etc.), as well as ankle sprains and inappropriate injuries. Landing (for example, skiers, rock climbers, acrobats, etc.) after a calcaneal fracture, the patient may also have complications such as compression fractures of the thoracolumbar spine, femoral neck fractures, acetabular fractures and tibial plateau fractures or ligament injuries due to factors in which violence can be transmitted through the limbs. Surgical treatment is often required. Patients with inconspicuous displacement of the articular surface usually undergo prying reduction. Patients with severe collapse of the articular surface and obvious displacement often undergo open reduction and internal fixation. However, due to the weakness of the adjacent soft tissue around the calcaneus, local soft tissue usually swells severely after high-energy trauma. In order to avoid postoperative complications such as wound dehiscence and infection, the operation is often delayed. It usually takes 8-19 days, up to 2-3 weeks. Methods: From January 2013 to January 2015, 15 patients with fresh calcaneal fractures (Sanders IIIAB, IIIAC, IIIBC and IV) who underwent open reduction and internal fixation were collected from the Third Hospital of Hebei Medical University. Patients were divided into two groups: group A received physical massage with pneumatic plantar pump 4 times a day, 1 hour a time, and group B received traditional elevation of the affected limb and gravitational detumescence therapy. Two methods of soft tissue detumescence were used before operation: 1. Physical massage therapy (experimental group), 4 times a day, 1 hour a time. The obvious dermatoglyphic sign appeared in the lateral soft tissue of the heel, that is, the wrinkle test was positive. The time interval between the two groups was recorded from post-traumatic fracture to the day of operation. The difference of time interval between the two groups was compared and statistically analyzed. Surgical treatment: AB patients in both groups were treated by lateral calcaneal approach. The incision began at 1.5 cm above the lateral malleolus of the affected foot and reached the junction of the dorsal skin and the metatarsal skin along the middle point of the posterior margin of the lateral malleolus and the anterior edge of the Achilles tendon, then turned horizontally to the fifth metatarsus. A single "L" incision was made in the lateral part of the base of the calcaneus, then the lateral area of the calcaneus was covered by the flap and the fibula muscle was pulled upward to expose the lateral area of the calcaneus. The average time from patients to operation day was 4-6 days, with an average of 5.44+0.73 days. The average time from patients with preoperative detumescence to operation day was 7.83+2.04 days. After statistical analysis, the difference between the two groups was statistically significant (P 0.05). One patient in group A had superficial wound infection after operation and was secreted. Staphylococcus aureus infection was diagnosed and sensitive to vancomycin after culture + drug sensitivity test; 1 case in group B was diagnosed as Acinetobacter baumannii after wound operation, which was sensitive to cefoperazone sulbactam after secretion culture + drug sensitivity test. 2 cases were sensitive to antibiotics by intravenous drip, and the wound healed after local physical therapy. Conclusion: The pneumatic plantar pump is a safe and reliable method for the treatment of soft tissue swelling of closed calcaneal fractures, which has the advantages of rapid detumescence, simplified treatment process, early operation time and less postoperative wound complications.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2248222
[Abstract]:OBJECTIVE: Fractures of the calcaneus are often caused by high-energy injuries, such as falling from high places (ladders, roofs, trees, windowsills, etc.) and in motor vehicle accidents (when a motor vehicle crashes frontally, the impact of the accelerator pedal or the brake pedal hits the sole of the foot, etc.), as well as ankle sprains and inappropriate injuries. Landing (for example, skiers, rock climbers, acrobats, etc.) after a calcaneal fracture, the patient may also have complications such as compression fractures of the thoracolumbar spine, femoral neck fractures, acetabular fractures and tibial plateau fractures or ligament injuries due to factors in which violence can be transmitted through the limbs. Surgical treatment is often required. Patients with inconspicuous displacement of the articular surface usually undergo prying reduction. Patients with severe collapse of the articular surface and obvious displacement often undergo open reduction and internal fixation. However, due to the weakness of the adjacent soft tissue around the calcaneus, local soft tissue usually swells severely after high-energy trauma. In order to avoid postoperative complications such as wound dehiscence and infection, the operation is often delayed. It usually takes 8-19 days, up to 2-3 weeks. Methods: From January 2013 to January 2015, 15 patients with fresh calcaneal fractures (Sanders IIIAB, IIIAC, IIIBC and IV) who underwent open reduction and internal fixation were collected from the Third Hospital of Hebei Medical University. Patients were divided into two groups: group A received physical massage with pneumatic plantar pump 4 times a day, 1 hour a time, and group B received traditional elevation of the affected limb and gravitational detumescence therapy. Two methods of soft tissue detumescence were used before operation: 1. Physical massage therapy (experimental group), 4 times a day, 1 hour a time. The obvious dermatoglyphic sign appeared in the lateral soft tissue of the heel, that is, the wrinkle test was positive. The time interval between the two groups was recorded from post-traumatic fracture to the day of operation. The difference of time interval between the two groups was compared and statistically analyzed. Surgical treatment: AB patients in both groups were treated by lateral calcaneal approach. The incision began at 1.5 cm above the lateral malleolus of the affected foot and reached the junction of the dorsal skin and the metatarsal skin along the middle point of the posterior margin of the lateral malleolus and the anterior edge of the Achilles tendon, then turned horizontally to the fifth metatarsus. A single "L" incision was made in the lateral part of the base of the calcaneus, then the lateral area of the calcaneus was covered by the flap and the fibula muscle was pulled upward to expose the lateral area of the calcaneus. The average time from patients to operation day was 4-6 days, with an average of 5.44+0.73 days. The average time from patients with preoperative detumescence to operation day was 7.83+2.04 days. After statistical analysis, the difference between the two groups was statistically significant (P 0.05). One patient in group A had superficial wound infection after operation and was secreted. Staphylococcus aureus infection was diagnosed and sensitive to vancomycin after culture + drug sensitivity test; 1 case in group B was diagnosed as Acinetobacter baumannii after wound operation, which was sensitive to cefoperazone sulbactam after secretion culture + drug sensitivity test. 2 cases were sensitive to antibiotics by intravenous drip, and the wound healed after local physical therapy. Conclusion: The pneumatic plantar pump is a safe and reliable method for the treatment of soft tissue swelling of closed calcaneal fractures, which has the advantages of rapid detumescence, simplified treatment process, early operation time and less postoperative wound complications.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前3条
1 余志才;王利;;跟骨骨折临床研究进展[J];当代医学;2013年14期
2 黄春燕;李笑琴;谢颖;许明;;加压冷疗用于跟骨骨折术前消肿的效果观察[J];岭南现代临床外科;2013年05期
3 罗显德;王景超;欧兆强;;抬高患肢结合冰敷在下肢骨折术后的应用[J];右江医学;2010年01期
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