CAJ | 학술논문

目的探讨软组织评估及干预策略在闭合性跟骨骨折治疗过程中的临床意义.方法前瞻性研究2005年2月至2011年7月收治的168例(207足)跟骨关节内移位骨折患者,男152例190足,女16例17足；年龄17 ～68岁,平均38.1岁.骨折按Sanders分型:Ⅱ型58足,Ⅲ型124足,Ⅳ型25足.采用自制的软组织评估标准进行评价,包括初始软组织评估和术前评估,并采取相应的临床干预措施.将所有患者随机分为3组,由资历相当的不同医生进行手术治疗,但术中及术后严格遵照上述特定的手术方式及流程进行处理.分析初始软组织评估严重程度与受伤至手术时间的相关性,受伤早期初始软组织评估、术前评估与伤口并发症的相关性,并比较3组患者术后伤口并发症的发生率.结果本组患者术后伤口并发症发生率为9.2％.初始软组织评估严重程度与受伤至手术时间成正相关(r=2.474,P=0.000),与骨折严重程度有密切关系(x2=109.829,P=0.000),且初始评估软组织肿胀程度和皮肤创面条件均对伤口预后有影响(P＜0.05).术前对软组织的3项评估(皱纹试验、毛细血管反应实验及经皮氧分压)对伤口并发症有明显影响(x2=440.961,P =0.000).3组患者伤口并发症发生率差异无统计学意义(P＞0.05). 结论重视软组织损伤、制定完善的围手术期软组织干预策略对闭合性跟骨骨折的治疗至关重要,可明显减少术后伤口并发症的发生
목적 탐토연조직평고급간예책략재폐합성근골골절치료과정중적림상의의.방법 전첨성연구2005년2월지2011년7월수치적168례(207족)근골관절내이위골절환자,남152례190족,녀16례17족；년령17 ～68세,평균38.1세.골절안Sanders분형:Ⅱ형58족,Ⅲ형124족,Ⅳ형25족.채용자제적연조직평고표준진행평개,포괄초시연조직평고화술전평고,병채취상응적림상간예조시.장소유환자수궤분위3조,유자력상당적불동의생진행수술치료,단술중급술후엄격준조상술특정적수술방식급류정진행처리.분석초시연조직평고엄중정도여수상지수술시간적상관성,수상조기초시연조직평고、술전평고여상구병발증적상관성,병비교3조환자술후상구병발증적발생솔.결과 본조환자술후상구병발증발생솔위9.2％.초시연조직평고엄중정도여수상지수술시간성정상관(r=2.474,P=0.000),여골절엄중정도유밀절관계(x2=109.829,P=0.000),차초시평고연조직종창정도화피부창면조건균대상구예후유영향(P＜0.05).술전대연조직적3항평고(추문시험、모세혈관반응실험급경피양분압)대상구병발증유명현영향(x2=440.961,P =0.000).3조환자상구병발증발생솔차이무통계학의의(P＞0.05). 결론 중시연조직손상、제정완선적위수술기연조직간예책략대폐합성근골골절적치료지관중요,가명현감소술후상구병발증적발생
Objective To evaluate the clinical significance of soft tissue assessment and intervention strategies to prevent postoperative wound complications in closed calcaneal fractures. Methods A prospeclive study over a 6-year period was conducted on 207 closed calcaneal fractures in 168 patients who had sought medical treatment in our department from February 2005 through July 2011 for closed calcaneal fractures.There were 152 men with 190 feet involved and 16 women with 17 feet involved.They were aged from 17 to 68 years (average,38.1 years).By Sanders classification,58 feet were of type Ⅱ,124 feet of type Ⅲ and 25 feet of type Ⅳ.A self-developed system of soft tissue assessment was adopted to evaluate the patients.including initial assessment and preoperative assessment, before clinical interventions were adopted accordingly. All patients were randomized into 3 groups who were taken care of by doctors with similar competence according to the same specified protocol.The associations were analyzed between initial soft tissue assessment and time interval from injury to operation, and between initial and preoperative soft tissue assessments and wound complications as well.The postoperative wound complications were compared between groups. Results The incidence of wound complications was 9.2％ in this series.The initial soft tissue assessment was positively correlated with the time interval from injury to operation ( r =2.474,P =0.000),closely associated with the severity of the fracture (x2 =109.829,P =0.000),and significantly associated with the wound prognosis ( P ＜ 0.05).Preoperative soft tissue assessment (including wrinkle test,capillary reaction test and percutaneous partial pressure of oxygen) had significant effects on the incidence of wound complications (x2 =440.961,P =0.000).There was no significant difference between the 3 groups in incidence of wound complications ( P ＞ 0.05). Conclusion It is important to conduct perioperative soft tissue assessments and to take intervention strategies accordingly for closed calcaneal fractures,because they can obbviously reduce the wound complications.