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骨盆骨折合并双侧股神经左侧坐骨神经损伤及尿道直肠损伤修复一例

NON-OPERATION RELATED RISK FACTORS OF WOUND COMPLICATIONS OF CALCANEAL FRACTURES USING LATERAL EXTENSIVE L-SHAPED INCISION

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.

骨盆骨折及股骨颈骨折合并股骨头盆腔内脱位一例

目的 总结骨盆骨折、股骨颈骨折合并股骨头盆腔内脱位的临床特点及治疗方法。 方法 患者，男，29岁。髋部压砸伤致骨盆骨折、右股骨颈骨折合并股骨头盆腔内脱位，髋臼骨折Letournel分型C型，骨盆骨折Tile分型C1.2型，股骨颈骨折Garden Ⅳ型。伤后7 d行切开复位内固定术，3枚空心钛钉固定股骨颈骨折，重建钛板固定骨盆骨折。 结果 术后3个月X线片示左侧髂骨、双侧耻骨支坐骨支骨折愈合。术后随访1年右股骨颈已部分愈合,无股骨头坏死征象。按照美国矫形外科研究院髋关节疗效评定标准， 功能恢复良。 结论 骨盆骨折、股骨颈骨折合并股骨头盆腔内脱位为少见而严重的高能量损伤，手术治疗是稳定骨折、恢复关节功能的一种有效方法。