2025 年第 4 期 第 20 卷

切口大小及缝合方式对跟骨骨折手术切口愈合及引流时间的影响分析

Analysis of the effect of incision size and suture method on incision healing and drainage time of calcaneal fracture surgery

作者：刘张章1齐岩松2胡三保1

英文作者：Liu Zhangzhang1 Qi Yansong2 Hu Sanbao1

单位：1首都医科大学附属北京安贞医院骨科，北京100029；2内蒙古自治区人民医院骨科中心（运动医学中心），呼和浩特010010

英文单位：1Department of Orthopedics Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Orthopedic Center (Sports Medicine Center) Inner Mongolia Autonomous Region People′s Hospital Hohhot 010010 China

关键词：跟骨骨折；切口愈合时间；跗骨窦入路；皮下缝合；皮肤粘合胶；切口并发症

英文关键词：Calcanealfracture;Woundhealingtime;Sinustarsalapproach;Subcutaneoussuture; Skinadhesive;Incisioncomplications

• 摘要：

• 目的 通过分析不同切口大小及缝合方式对跟骨骨折手术切口愈合情况的影响，明确影响跟骨切口愈合的独立性因素。方法 本研究为同期平行对照临床研究。选取2018年1月至2020年12月在首都医科大学附属北京安贞医院骨科急诊行跟骨骨折切开复位内固定术的120例患者作为研究对象，按照入院时间顺序依次纳入A组（传统外侧L切口+间断褥式缝合）、B组（传统外侧L切口+皮下缝合）、C组（传统外侧L切口+伤口粘合胶）、D组（有限切开+间断褥式缝合）、E组（有限切开+皮下缝合）、F组（有限切开+伤口粘合胶），每组20例，比较各组缝合时间、引流时间、切口愈合时间、住院时间等临床指标。结果 同一切口方法组间比较显示，C组缝合时间、引流时间均明显短于A、B组，F组切口缝合时间、引流时间均明显短于D、E组；E组引流时间明显短于D组（均P<0.05）；有限切开组与传统切口组比较，D组缝合时间明显短于A组，E组缝合时间明显短于B组（均P<0.05）。同一缝合方式组间比较显示，D、E、F组的引流时间均分别短于A、B、C组，F组的切口愈合时间明显短于C组（均P<0.05）。相关性分析结果显示，切口大小、缝合方式与引流时间（r=-0.360、-0.575，均P<0.001）、切口愈合时间（r=-0.284，P=0.002；r=-0.203，P=0.026）之间均具有相关性，此外，切口大小、切口愈合时间还与住院时间之间具有相关性（r=0.116、P=0.021；r=0.779、P<0.001）。多元线性回归分析结果显示，切口大小及缝合方式均为影响引流时间的独立性因素（均P<0.001），而切口大小则是影响切口愈合时间的唯一独立性因素（P=0.002）。结论 跟骨骨折手术切口的引流时间受切口大小、缝合方式影响，而切口愈合只受切口大小的影响。有限切开+伤口粘合胶的方式具有缩短引流时间和切口愈合时间双重优势。

• Objective To analyze the influence of different incision size and suture methods  on the healing of calcaneal fracture incision, and to identify the independent factors affecting the healing of calcaneal incision. Methods This study was a contemporaneous parallel controlled clinical study. A total of 120 patients who underwent emergency open reduction and internal fixation of calcaneal fractures in Department of Orthopedics, Beijing Anzhen Hospital, Capital Medical University from January 2018 to December 2020 were selected as the research objects. According to the order of admission, they were divided into groups A (traditional lateral incision + intermittent mattress suture), B (traditional lateral incision + subcutaneous suture), C (traditional lateral incision + wound adhesive), D (limited incision + intermittent mattress suture), E (limited incision + subcutaneous suture), F (limited incision + wound adhesive), with 20 cases in each group. The suture time, drainage time, incision healing time, hospital stay and other clinical indicators were compared between the groups. Results The comparison between groups with the same incision method showed that the suture time and drainage time in group C were significantly shorter than those in groups A and B, and the suture time and drainage time in group F were significantly shorter than those in groups D and E. The drainage time in group E was significantly shorter than that in group D (all P<0.05). The limited incision group was compared with the traditional incision group, the suture time in group D was significantly shorter than that in group A, and the suture time in group E was significantly shorter than that in group B (both P<0.05). The comparison between groups with the same suture method showed that the drainage time of groups D, E, and F was shorter than that of groups A, B, and C, respectively. The wound healing time of group F was significantly shorter than that of group C (all P<0.05). The results  of correlation analysis showed that the incision size and suture method were correlated with drainage time(r=-0.360, -0.575, both P<0.001) and wound healing time(r=-0.284, P=0.002; r=-0.203, P=0.026). In addition, the incision size and wound healing time were also correlated with the length of hospital stay(r=0.116, P=0.021; r=0.779, P<0.001). The results  of multiple linear regression analysis showed that the incision size and suture method were both independent factors affecting the drainage time (both P<0.001), and the incision size was the only independent factor affecting the incision healing time (P=0.002). Conclusions  Incision drainage time of calcaneal fractures is affected by incision size and suture method, while incision healing is only affected by incision size. The method of limited incision + wound adhesive has the advantages of shortening the drainage time and wound healing time.