Titanium plate combined with bone graft and internal fixation for calcaneal fractures: influencing factors for lateral L-shaped incision healing

doi:10.3969/j.issn.2095-4344.2016.26.012

Abstract

Abstract:

BACKGROUND: Calcaneus has its special anatomy. Moreover, it is difficult to expose the inside to the posterior side of the joint surface. Lateral calcaneal soft tissue was less. The joint surface can be clearly exposed after incision, so lateral L-shaped incision is conventionally used in calcaneal surgery.

OBJECTIVE: To analyze the suspicious factors influencing the open reduction titanium plate for calcaneal fracture and internal fixation of L-shaped wound healing during bone graft.

METHODS: A total of 84 cases (94 sides) of calcaneal fractures, who were treated in the Disabled Rehabilitation Center in Liaoning Province from June 2011 to November 2014, were included in this study. They were grouped according to the source of bone graft. Allograft group contained 52 sides (44 cases). Autogenous iliac bone graft group contained 42 sides (40 cases). Operation time of calcaneus was 7-10 days after injury. L-shaped incision was made for open reduction and internal fixation with titanium plate and bone graft. The patient’s age, the type of bone graft, type of drainage and drainage time that may cause the incision complications were investigated and analyzed.

RESULTS AND CONCLUSION: (1) Among 84 cases of 94 calcaneal fractures after operation, 16 sides affected complications. (2) Significant differences in the incidence of complications were detected between negative pressure drainage and skin flap drainage (P < 0.05). Negative pressure drainage had a significant effect on reducing the incidence of incision complications. (3) Significant differences in the incidence of incision complications were determined between the allograft group and autogenous iliac bone graft group (P < 0.05). Implantation of autogenous iliac bone could significantly reduce the incidence of incision complications. (4) No significant difference was detected between the complication group and non-complication group in age and drainage time (P > 0.05). (5) These findings indicate that 7-10 days after injury, operation after the swelling subsided completely, the negative pressure drainage, and planting autogenous iliac crest can reduce the incidence of complications related to lateral calcaneal L-shaped incision.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Calcaneus, Fractures, Bone, Bone Transplantation, Internal Fixators, Tissue Engineering

CLC Number:

R318

Zhang Bai, Qi Xiu, Han Zuo-feng, Zhang Ying. Titanium plate combined with bone graft and internal fixation for calcaneal fractures: influencing factors for lateral L-shaped incision healing[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(26): 3876-3882.

Figures/Tables 3

54侧行皮片引流的切口中出现并发症的有16侧(同种异体骨移植组12侧，自体髂骨移植组4侧)。其中4侧出现切口感染，经长期换药切口不能愈合，于术后两至三个月时取内固定钛板，局部皮瓣转移后愈合；5侧出现切口延迟愈合，切口皮缘坏死，经长期换药不能愈合，行局部皮瓣转移术后愈合，3侧切口延迟愈合经长期局部换药后切口愈合。 40侧行负压引流的切口中，出现并发症的有2侧(植同种异体骨1侧，植自体髂骨1侧)。其中1侧由于早期引流量多，引流管堵塞，造成渗血由切口渗出，其中1侧切口长期换药不愈合，后行皮瓣转移，另1侧为拆线时，切口裂开，切口内挤出淡黄色液体，培养为无细菌生长，后经长期换药，切口愈合。负压引流的切口并发症明显少于皮片引流。从植骨来看，42例植自体髂骨出现切口并发症3侧，52例植同种异体骨出现切口并发症15侧，自体髂骨移植组并发症发生率明显低于同种异体骨移植组(P < 0.05)。 2.5 典型病例分析典型病例1：男性患者，42岁，高处跌落伤，双足跟着地，即见双足跟肿痛，不能站立，入院后影像学检查提示：右脚跟骨重度塌陷粉碎性骨折，Bohler角负6°(图3A，B)，Gissane角80.4°。入院消肿后行切开复位钛板内固定联合自体骨移植。术后双跟距关节达解剖复位(图3C，D)，Bohler角恢复至34°，Gissane角恢复至127.8°，随访12个月见足部功能恢复正常。典型病例2：女性患者，37岁，车祸致伤，双脚根部出现肿痛，无法行走，入院后影像学检查提示：双跟骨重度塌陷粉碎性骨折，Bohler角右侧0°，左侧负5°(图4A，B)，Gissane角右侧85.2°，左侧80.4°。入院处理后行切开复位钛板内固定联合异体骨移植。术后双跟距关节达解剖复位(图4C，D)，Bohler角分别恢复至34°和35°，Gissane角分别恢复至127.8°，130.2°，随访10个月后双足功能基本恢复正常。"

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