本文選題：跟骨　切入點(diǎn)：骨折　出處：《山西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:跟骨骨折在臨床較為常見,多發(fā)于中輕年人群,90%為男性,男女發(fā)病比例為5.96:1。跟骨骨折術(shù)后的并發(fā)癥發(fā)生率較高,包括后足增寬,腓骨長(zhǎng)短肌撞擊,距下關(guān)節(jié)僵硬,骨折的畸形愈合,骨折感染,傷口壞死,進(jìn)行性骨關(guān)節(jié)病等。其中術(shù)后切口并發(fā)癥,特別是切口的壞死,對(duì)醫(yī)生和患者來說都是災(zāi)難性的后果。引起跟骨骨折術(shù)后切口并發(fā)癥發(fā)生是多因素造成的,故本研究的目的在于:(1)將可能影響跟骨骨折術(shù)后切口并發(fā)癥的相關(guān)因素進(jìn)行單因素分析,找出與切口并發(fā)癥發(fā)生的相關(guān)因素。(2)將相關(guān)危險(xiǎn)因素進(jìn)行多因素分析,發(fā)現(xiàn)危險(xiǎn)因素與切口并發(fā)癥之間的關(guān)系,為臨床降低跟骨骨折術(shù)后切口并發(fā)癥發(fā)生做出參考。方法:(1)使用回顧性研究的方法,對(duì)山西醫(yī)科大學(xué)第二醫(yī)院骨科第四病區(qū)自2012年2月至2014年12月期間116位患者129例的病例資料進(jìn)行統(tǒng)計(jì)分析研究。(2)采用SPSS 17.O統(tǒng)計(jì)軟件對(duì)可能影響跟骨骨折術(shù)后切口并發(fā)癥發(fā)生的9個(gè)因素進(jìn)行單因素分析,對(duì)有統(tǒng)計(jì)學(xué)意義的因素再進(jìn)行多因素Logistic回歸分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:129側(cè)跟骨骨折后進(jìn)行了12-36月(平均18.6個(gè)月)的隨訪,共有16例出現(xiàn)切口并發(fā)癥:3例(3.1%)鋼板外露,5例(2.3%)血腫形成,7例(2.3%)皮緣壞死,1例(0.7%)骨髓炎。單因素分析結(jié)果示:吸煙,糖尿病及高血壓患者,手術(shù)時(shí)機(jī),手術(shù)時(shí)間,牽拉方法,引流方式8個(gè)因素與切口并發(fā)癥的發(fā)生相關(guān)。多因素Logistic回歸分析結(jié)果顯示:(1)吸煙指數(shù)每增加一個(gè)等級(jí),并發(fā)癥的發(fā)生風(fēng)險(xiǎn)增加了1.046倍;(2)采用普通引流的并發(fā)癥發(fā)生風(fēng)險(xiǎn)是使用置管沖洗引流的6.847倍;(3)手術(shù)時(shí)機(jī)≤7d的并發(fā)癥發(fā)生風(fēng)險(xiǎn)是手術(shù)時(shí)機(jī)8-14天6.067倍,手術(shù)時(shí)機(jī)14d的并發(fā)癥發(fā)生風(fēng)險(xiǎn)是手術(shù)時(shí)機(jī)8-14天2.079倍;(4)采用靜態(tài)牽拉方法的并發(fā)癥發(fā)生的風(fēng)險(xiǎn)是采用動(dòng)態(tài)牽拉方法的2.519倍。結(jié)論:吸煙指數(shù),手術(shù)時(shí)機(jī)的選擇,牽拉方法,引流方式是跟骨切口并發(fā)癥發(fā)生的高危因素。通過禁煙,嚴(yán)格控制血糖,選擇恰當(dāng)?shù)氖中g(shù)時(shí)機(jī),術(shù)中由經(jīng)過訓(xùn)練的醫(yī)師行動(dòng)態(tài)牽拉,使用置管沖洗引流可能有助于減少跟骨骨折術(shù)后切口并發(fā)癥的發(fā)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，

本文編號(hào)：1585589