應(yīng)用氣壓足底泵治療閉合性跟骨骨折周圍軟組織腫脹治療效果的臨床觀察
發(fā)布時間：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損傷所導(dǎo)致,如從高處墜落(梯子、屋頂、樹以及窗臺等)和在機(jī)動車交通事故中(當(dāng)機(jī)動車正面碰撞時油門踏板或制動踏板的沖擊力撞擊足底導(dǎo)致骨折等)等,此外還包括踝部的扭傷以及不當(dāng)?shù)闹?如滑雪運(yùn)動員、攀巖愛好者及雜技演員等),在跟骨發(fā)生骨折后由于暴力可以通過肢體傳導(dǎo)的因素,患者通常可能還會合并脊柱胸腰段的壓縮性骨折,股骨頸骨折、髖臼骨折以及脛骨平臺骨折或韌帶損傷等并發(fā)癥狀。跟骨骨折的患者常常需要進(jìn)行手術(shù)治療,關(guān)節(jié)面移位不明顯的患者一般行撬撥復(fù)位術(shù)治療,而關(guān)節(jié)面嚴(yán)重塌陷并明顯移位的患者常需行切開復(fù)位內(nèi)固定術(shù),但因?yàn)楦侵車彽能浗M織較為薄弱,局部軟組織在高能量創(chuàng)傷后通常會嚴(yán)重腫脹,在實(shí)際臨床工作當(dāng)中為避免術(shù)后傷口裂開、感染等并發(fā)癥狀的出現(xiàn),經(jīng)常需要將手術(shù)延遲,一般需要8~19天,最長多達(dá)2~3周。本研究通過觀察記錄應(yīng)用氣壓足底泵治療閉合性跟骨骨折術(shù)前周圍軟組織腫脹的情況,分析評價應(yīng)用氣壓足底泵治療術(shù)前閉合性跟骨骨折周圍軟組織腫脹臨床療效,為臨床治療工作提供參考依據(jù)。方法:收集自2013年1月至2015年1月河北醫(yī)科大學(xué)第三醫(yī)院收治的15例新鮮跟骨骨折(骨折分型為Sanders IIIAB、IIIAC、IIIBC及IV)且行切開復(fù)位內(nèi)固定術(shù)的患者為研究對象,將患者分為A B兩組,入院當(dāng)天即開始治療,A組患者應(yīng)用氣壓足底泵進(jìn)行物理按摩治療,4次/日,1h/次,此組為實(shí)驗(yàn)組;B組患者采用傳統(tǒng)抬高患肢,利用重力因素消腫治療,此組為實(shí)驗(yàn)組。兩種術(shù)前軟組織消腫方法:1.應(yīng)用氣壓足底泵對傷肢進(jìn)行物理按摩治療(實(shí)驗(yàn)組),4次/日,1小時/次。2.采用傳統(tǒng)抬高制動患肢(對照組),利用重力因素進(jìn)行消腫治療。手術(shù)治療方式:臨床消腫療效的判定標(biāo)準(zhǔn)及術(shù)后傷口記錄標(biāo)準(zhǔn):分別于兩組患者入院后每日檢查患者傷足腫脹情況,直至傷足足跟部外側(cè)軟組織出現(xiàn)較為明顯的皮紋征,即皺褶實(shí)驗(yàn)陽性,記錄患者從創(chuàng)傷骨折后直至手術(shù)當(dāng)日的時間區(qū)間,比較兩組間時間區(qū)間的差別并進(jìn)行統(tǒng)計(jì)學(xué)分析,同時記錄兩組患者術(shù)后傷口的愈合情況,傷口輕度滲出、發(fā)紅為表淺感染;傷口裂開同時伴膿性分泌物為深部感染。手術(shù)治療方式:AB兩組患者均采用跟骨外側(cè)手術(shù)入路方式,手術(shù)切口始于患足外踝上1.5 cm處,沿外踝后緣與跟腱前緣中點(diǎn)向下到達(dá)足背外側(cè)皮膚與跖骨皮膚的交界處,然后再轉(zhuǎn)向水平方向切至第五跖骨基底外側(cè)部,呈單一“L”型切口,隨后將跟骨外側(cè)區(qū)覆蓋皮瓣全部掀起,腓骨肌向上方牽開,充分暴露跟骨外側(cè)區(qū)域術(shù)野,采用No-touch技術(shù),直視下復(fù)位骨折斷端,最終置入跟骨重建鋼板固定。結(jié)果:應(yīng)用氣壓足底泵進(jìn)行術(shù)前消腫治療的患者至術(shù)日當(dāng)天歷時4~6天,平均5.44±0.73天,應(yīng)用傳統(tǒng)抬高患肢方法進(jìn)行術(shù)前消腫的患者至術(shù)日歷時4~10天平均7.83±2.04天,經(jīng)統(tǒng)計(jì)學(xué)分析后,兩組間時間差異具有統(tǒng)計(jì)學(xué)意義(P0.05);試驗(yàn)過程中A組中有1例患者術(shù)后傷口為表淺感染,經(jīng)分泌物培養(yǎng)+藥敏試驗(yàn)后診斷為金黃色葡萄球菌感染,對萬古霉素敏感;B組中有1例患者術(shù)后傷后為表淺感染,經(jīng)分泌物培養(yǎng)+藥敏試驗(yàn)后診斷為鮑曼不動桿菌,對頭孢哌酮舒巴坦敏感,2例患者經(jīng)靜脈滴注敏感抗生素、傷口局部理療后,傷口愈合良好,均無深部感染的出現(xiàn)。結(jié)論:應(yīng)用氣壓足底泵治療術(shù)前跟骨閉合性骨折軟組織腫脹,具有安全可靠,快速消腫、簡化治療過程、提前手術(shù)時機(jī)且術(shù)后傷口并發(fā)癥較少等優(yōu)點(diǎn),是一種較好治療軟組織腫脹的方法。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：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.
【學(xué)位授予單位】：河北醫(yī)科大學(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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相關(guān)期刊論文 前3條
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2 黃春燕;李笑琴;謝穎;許明;;加壓冷療用于跟骨骨折術(shù)前消腫的效果觀察[J];嶺南現(xiàn)代臨床外科;2013年05期
3 羅顯德;王景超;歐兆強(qiáng);;抬高患肢結(jié)合冰敷在下肢骨折術(shù)后的應(yīng)用[J];右江醫(yī)學(xué);2010年01期
，本文編號：2248222
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