Objective To analyze the non-operation related risk factors of the wound complications by using lateral extensive L-shaped incision for open reduction and internal fixation of calcaneal fractures. Methods A retrospective analysis was made on the clinical data of 58 patients with closed calcaneal fractures (63 calcaneus) treated by using lateral intensive L-shaped incision for open reduction and internal fixation between September 2006 and August 2011. There were 52 males (56 calcaneus) and 6 females (7 calcaneus), aged 18 to 64 years (mean, 35 years). The causes of injury included fall injury in 53 cases (58 calcaneus), traffic injury in 5 cases (5 calcaneus). The mean time between injury and operation was 8 days (range, 3-22 days). According to Sanders classification, 4 calcaneus were rated as type II, 31 calcaneus as type III, and 28 calcaneus as type IV. Postoperative complications were observed and graded; 58 patients were divided into complication group (≥grade 2) and control group (lt; grade 2). The univariate analysis was used to analyze 18 factors which may lead to wound complications; multi-factor unconditioned logistic regression analysis was done for the factors showing significant difference. Results According to postoperative wound complications grading, 41 patients (46 calcaneus) were included in the control group, whose incision healed primarily, and 17 patients (17 calcaneus) in the complication group. In 17 patients of the complication group, 14 had skin necrosis or dehiscence, and 3 had superficial infection; they obtained healing after symptomatic treatment. The univariate analysis showed significant differences in combined spinal fracture, diabetes mellitus, and long-term smoking between 2 groups (P lt; 0.05). The logistic regression analysis revealed that combined spinal fracture was an independent risk factor for wound complications (95% confidence interval: 0.004-0.360, P=0.004). Conclusion Combined spinal fracture is an independent risk factor for wound complications after open reduction and internal fixation of calcaneal fracture using lateral extensive L-shaped incision.
目的比较全层连续缝合法和分层缝合法在急诊腹部手术中的切口愈合效果。 方法将符合纳入标准的急诊腹部手术患者随机分为全层缝合组和分层缝合组，比较2组患者的切口愈合效果。 结果全层缝合组的关腹时间短于分层缝合组（P=0.000），但在切口液化发生率、切口感染发生率、总切口并发症发生率、切口愈合及术后住院时间方面，2组的差异均无统计学意义（P＞0.05）。26例细菌培养结果为阳性（全层缝合组10例，分层缝合组16例）的患者中，致病菌主要为大肠埃希菌（11例）和铜绿假单胞菌（7例）。 结论相较于分层缝合法，急诊腹部手术中采用全层缝合法既不增加切口并发症的发生率，又节省手术时间，对于危重患者具有重要的意义。