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7~14 d,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.%Objective To analyze the causes of incision skin flap necrosis after intra-articular calcaneal fracture surgery and explore the measures for improving the healing of incision skin flap after calcaneal fracture surgery. Methods A total of 53 cases with calcaneal fracture admitted in our department from March 2010 to November 2014 were given open reduction and internal fixation with plate. Timing of surgery 7-14 days. All the patients were treated by lateral approach to calcaneus and titanium plate fixation, postoperative negative pressure drainage via the No. 12 silicone drainage tube inserted in the dorsal puncture, and the incision without elastic bandage. Results The complication such as incision skin flap necrosis oc-curred in 1 case after surgery, with the incidence was 1.9%. After debridement and dressing, the skin appeared defect and the internal fixator exposed, but the wound was closed after the second surgery of sural nerve reverse island skin flap re-pairing. Conclusion The appropriate time for operation, gentle surgical practices, and adequate drainage are the key to re-ducing the wound complications.