Objective To compare the efficacy between three-layer suture and Allg(o)wer-Donati suture on wound healing.Methods From September 2016 to June 2018,patients with Sanders type Ⅲ calcaneal fracture were randomly divided into two groups:three-layer close suture group (26 cases,18 males and 8 females,aged 19-48 years,with an average age of 33.69±8.84 years) and Allg(o)wer-Donati group (26 cases,19 males and 7 females,aged 19-49 years,with an average age of 32.38±8.45 years).The traditional L-shaped incision was used in all patients.The inflammatory reaction area of incision,skin temperature change at the corner of L-shaped incision line and the healing grade of incision were compared between the two groups.Results 52 patients were followed up for 6 months.At 2 weeks after operation,the inflammatory reaction area of incision skin in the three-layer close skin suture group (26.46±9.37 mm2) was smaller than that in Allg(o)wer-Donati suture group (33.16±9.33 mm2).There was a significant difference between the two groups (t=2.584,P=0.013).There was no difference in skin temperature at the comer of Lshaped incision between the two groups before and on the first day after operation.However,the incision skin temperature of the three-layer close suture group on the 2nd and 3rd day after operation [(36.47±0.33)℃ and (36.54±0.22)℃] was higher than that of Allg(o)wer-Donati group [(36.20±0.42)℃ and (36.22±0.43)℃].The difference was statistically significant (t=2.61,P=0.01;t=3.48,P=0.001).There were 25 cases of Class A healing and 1 case of Class B healing in three-layer close suture group,with Class A healing rate of 96.15％ (25/26).In Allg(o)wer-Donati group,there were 22 cases of Class A healing,1 case of Class B healing,and 3 cases of Class C healing,with Class A healing rate of 84.62％ (22/26).Among all grade B healing incisions,1 case had a small amount of local hemorrhagic exudation in the three-layer close suture group,while 1 case had a black necrosis at the edge of the incision,3 cases had a purulent incision and exposed steel plate in the Allg(o)wer-Donati group.Conclusion In the treatment of L-shaped incision of calcaneal fracture,three-layer close suture is a better method than Allg(o)wer-Donati suture because of smaller inflammatory reaction area of incision,higher skin temperature change at the comer of L-shaped incision on the 2nd and 3rd day after operation,higher rate of first-degree healing of incision and slighter incision complications.%目的 比较三层紧密缝合法与Allg(o)wer-Donati缝合法对切口愈合的影响.方法 2016年9月至2018年6月,采用非盲法、开放性随机对照试验,将SandersⅢ型跟骨骨折患者随机分为两组,分别采用三层紧密缝合法[26例,男18例,女8例;年龄19～48岁,平均(33.69±8.84)岁]和Allg(o)wer-Donati缝合法[26例,男19例,女7例;年龄19～49岁,平均(32.38±8.45)岁]关闭切口.所有患者跟骨骨折手术切口均采用传统“L”形大切口.术后比较两组患者的切口炎性反应面积、“L”形切口拐角处皮肤温度变化、切口愈合等级.结果 术后52例患者均获得6个月随访.术后2周拆线时,三层紧密缝合组切口皮肤炎性反应面积[(26.46±9.37) mm2]小于Allg(o)wer-Donati组[(33.16±9.33) mm2],两者比较差异有统计学意义(t=2.584,P=0.013).“L”形切口拐角处皮肤温度变化,术前、术后第1天两组无差异,术后第2、3天三层紧密缝合组切口皮肤温度[(36.47±0.33)℃和(36.54±0.22)℃]均高于Allg(o)wer-Donati组[(36.20±0.42)℃和(36.22±0.43)℃],差异有统计学意义(t=2.61,P=0.01;t=3.48,P=0.001).三层紧密缝合组:甲级愈合25例,乙级愈合1例,甲级愈合率96.15％(25/26);Allg(o)wer-Donati组:甲级愈合22例,乙级愈合1例,丙级愈合3例,甲级愈合率84.62％(22/26).三层紧密缝合组26例患者只有1例局部有少量血性渗液的乙级愈合切口,而Allg(o)wer-Donati组1例乙级愈合切口边缘发黑坏死,3例切口化脓,钢板外露.结论 采用三层紧密缝合方法处理跟骨骨折“L”形手术切口较Allg(o)wer-Donati缝合法,术后切口炎性反应面积更小、“L”形切口拐角处皮肤温度变化在术后第2、3天更高、切口甲级愈合率更高,切口并发症表现轻微,是一种更好的缝合方法.
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