本文選題：負(fù)壓封閉引流 + 跟骨骨折��； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：背景跟骨骨折在足部骨折中比較常見,跗骨骨折中約有60%為跟骨骨折。跟骨骨折多由高能量損傷所致,以高處墜落,足跟受到撞擊最常見。跟骨骨折損傷機(jī)制復(fù)雜,分類方法較多,治療方式不統(tǒng)一,最常用的還是手術(shù)治療。但是由于跟骨及其周圍組織解剖結(jié)構(gòu)復(fù)雜,軟組織覆蓋差等原因,術(shù)后出現(xiàn)切口裂開、壞死、感染的概率較大,甚至導(dǎo)致創(chuàng)傷性關(guān)節(jié)炎。負(fù)壓封閉引流技術(shù)(VSD)于1992年開始出現(xiàn),現(xiàn)在已經(jīng)成為一種處理難愈合傷口的標(biāo)準(zhǔn)治療方法。與其他引流技術(shù)相比,負(fù)壓封閉引流技術(shù)能夠進(jìn)行高效、全方位的引流。它不僅能夠?qū)⒀�、滲出液和壞死組織引流出體外,還能填塞于創(chuàng)面空腔,促進(jìn)感染腔隙的閉合。目前,負(fù)壓封閉引流技術(shù)已經(jīng)被廣泛應(yīng)用于復(fù)雜軟組織損傷、開放性骨折等方面,但是在預(yù)防手術(shù)切口并發(fā)癥方面,尚未有太多的報(bào)道。目的探討用負(fù)壓封閉引流預(yù)防跟骨骨折切開復(fù)位內(nèi)固定術(shù)后切口并發(fā)癥的臨床療效。方法從山東大學(xué)第二醫(yī)院骨外科于2012年5月至2014年12月期間治療的跟骨骨折患者中選取病歷資料較完善的73例81足進(jìn)行回顧性分析。選取的患者均診斷為跟骨閉合性骨折,屬于跟骨Sanders分類中的Ⅱ型～Ⅲ型,給予行骨折切開復(fù)位內(nèi)固定術(shù),手術(shù)均采用跟骨外側(cè)“L"形切口切開復(fù)位,骨質(zhì)缺損者取自體髂骨或人工骨植入,使用跟骨鈦鋼板及螺釘固定,2-0絲線逐層縫合至皮膚。將患者按照引流方式的不同分為負(fù)壓封閉引流組、自制負(fù)壓引流組和橡皮條引流組：負(fù)壓封閉引流組11例13足,術(shù)后給予切口負(fù)壓封閉引流；自制負(fù)壓引流組27例29足,術(shù)后以紗布墊自制負(fù)壓引流；橡皮條引流組35例39足,術(shù)后給予切口橡皮條引流,常規(guī)換藥。通過比較三組患者術(shù)后切口引流時(shí)間、切口愈合時(shí)間、切口并發(fā)癥發(fā)生情況,評價(jià)預(yù)防性使用負(fù)壓封閉引流對跟骨骨折術(shù)后切口并發(fā)癥的臨床療效。結(jié)果在切口引流時(shí)間方面,負(fù)壓封閉引流組為5(4,5)天,自制負(fù)壓引流組為5(4,5)天,橡皮條引流組為2(2,2)天。引流方式對術(shù)后切口引流時(shí)間的影響有統(tǒng)計(jì)學(xué)差異(H=66.703,p=0.000)。組內(nèi)多重比較：負(fù)壓封閉引流組與自制負(fù)壓引流組的引流時(shí)間差異無統(tǒng)計(jì)學(xué)意義(H=2.589,p=1.000),而橡皮條引流組與該兩組的引流時(shí)間差異均有統(tǒng)計(jì)學(xué)意義(H=42.090,p=0.000；H=39.501,p=0.000)。在切口愈合時(shí)間方面,負(fù)壓封閉引流組為16(14,16)天,自制負(fù)壓引流組為15(15,18)天,橡皮條引流組為18(15,24)天。引流方式對術(shù)后切口愈合時(shí)間的影響有統(tǒng)計(jì)學(xué)差異(H=8.622,p=0.013)。組內(nèi)多重比較：負(fù)壓封閉引流組與自制負(fù)壓引流組的切口愈合時(shí)間差異無統(tǒng)計(jì)學(xué)意義(H=-4.438,p=1.000),與橡皮條引流組的切口愈合時(shí)間差異有統(tǒng)計(jì)學(xué)意義(H=-17.949,p=0.048),自制負(fù)壓引流組與橡皮條引流組的切口愈合時(shí)間差異無統(tǒng)計(jì)學(xué)意義(H=-13.511,p=0.053)。在術(shù)后切口并發(fā)癥方面,負(fù)壓封閉引流組出現(xiàn)1例切口邊緣少量發(fā)黑壞死,切口并發(fā)癥發(fā)生率為7.69%。自制負(fù)壓引流組出現(xiàn)2例切口皮緣發(fā)黑壞死,1例切口愈合不良,切口并發(fā)癥的發(fā)生率為10.34%。橡皮條引流組中有8例出現(xiàn)有切口部分皮緣壞死、切口裂開,3例切口脂肪液化壞死,切口感染不愈合,切口并發(fā)癥的發(fā)生率為28.21%。引流方式對術(shù)后切口并發(fā)癥發(fā)生率的影響有統(tǒng)計(jì)學(xué)差異(χ2=6.591,p=0.031)。負(fù)壓封閉引流組與自制負(fù)壓引流組的并發(fā)癥發(fā)生率差異無統(tǒng)計(jì)學(xué)意義(χ2=0,459,p=1.000),而橡皮條引流組與該兩組的并發(fā)癥發(fā)生率差異均有統(tǒng)計(jì)學(xué)意義(χ2=10.686,p=0.013)。結(jié)論跟骨骨折切開復(fù)位內(nèi)固定術(shù)后,應(yīng)用負(fù)壓封閉引流可延長引流時(shí)間,明顯降低切口并發(fā)癥的發(fā)生率,但是對于縮短切口愈合時(shí)間的作用尚不確切,仍需進(jìn)一步研究。自制負(fù)壓引流是對負(fù)壓封閉引流的一種模擬方式,對于經(jīng)濟(jì)條件較差的患者,不失為一個(gè)良好的選擇。
[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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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