敏感性皮肤与踝关节骨折切开复位内固定术后并发切口感染、皮肤坏死关系的临床研究

目的:探讨敏感性皮肤与踝关节骨折切开复位内固定术后并发切口感染、皮肤坏死的关系。方法:选择2014年1月至2019年12月接受常规入路切开复位内固定治疗的踝关节骨折患者为研究对象。根据Baumann敏感性-耐受性皮肤分类法将入组患者分为敏感性皮肤组和耐受性皮肤组。随访记录相关指标,比较2组患者切口感染、皮肤坏死的发生率以及2组并发皮肤坏死患者的坏死皮肤面积、切口愈合时间、抗生素使用时间。结果:共纳入321例踝关节骨折患者,敏感性皮肤组115例,耐受性皮肤组206例。敏感性皮肤组术后切口感染发生率和皮肤坏死发生率均高于耐受性皮肤组(χ²=5.716,P=0.017;χ²=16.759,P=0.000);敏感性皮肤组中并发皮肤坏死患者的坏死皮肤面积、切口愈合时间、抗生素使用时间均大于(或长于)耐受性皮肤组中并发皮肤坏死患者[(12.29±6.81)cm2,(8.35±3.39)cm2,t=2.189,P=0.037;(12.67±4.91)d,(6.50±2.17)d,t=4.915,P=0.000;(19.80±6.93)d,(12.50±3.74)d,t=3.693,P=0.002]。结论:敏感性皮肤患者与耐受性皮肤患者相比,踝关节骨折切开复位内固定术后切口感染、皮肤坏死的发生率均较高,且坏死皮肤面积更大、愈合更加困难。

A clinical study on the relationship between sensitive skin and incidence rates of incision infection and skin necrosis after surgery of open reduction and internal fixation for treatment of ankle fractures

Objective:To explore the relationship between sensitive skin and incidence rates of incision infection and skin necrosis af-ter surgery of open reduction and internal fixation for treatment of ankle fractures.Methods:The patients who received open reduction and internal fixation through conventional approaches for treatment of ankle fractures from January 2014 to December 2019 were selected as the subjects,and were divided into sensitive skin group and tolerant skin group according to Baumann sensitivity-tolerance skin type classifica-tion.The related indicators were recorded at follow-up visits.The incidence rates of postoperative incision infection and skin necrosis and the skin necrotic area,incision healing time and duration of antibiotic use of postoperative patients who suffered skin necrosis were compared between the 2 groups.Results:Three hundred and twenty-one patients were enrolled in the study,115 cases in sensitive skin group and 206 cases in tolerant skin group.The incidence rates of postoperative incision infection and skin necrosis were higher in sensitive skin group compared to tolerant skin group(χ²=5.716,P=0.017;χ²=16.759,P=0.000).The skin necrotic area was larger,and the incision heal-ing time and duration of antibiotic use were longer in sensitive skin group compared to tolerant skin group in postoperative patients who suf-fered skin necrosis(12.29±6.81 vs 8.35±3.39 cm(2),t=2.189,P=0.037;12.67±4.91 vs 6.50±2.17 days,t=4.915,P=0.000;19.80±6.93 vs 12.50±3.74 days,t=3.693,P=0.002).Conclusion:The incidence rates of postoperative incision infection and skin necrosis are higher in sensitive skin patients compared to tolerant skin patients after the surgery of open reduction and internal fixation for treatment of ankle fractures,and the skin necrotic area is larger and skin healing is more difficult in the former.