Analysis The Risk Factors Of Incision Complications Following Closed Calcaneal Fracture Operation

ObjectiveIn clinic,complications such as poor incision healing,infection,and flap necrosis often occur after open reduction and internal fixation(ORIF)of closed calcaneal fractures.Some cases are prolonged,According to the statistics,the incidence of incision complications is about 19%-37%.This study focuses on the factors that may affect the incision healing after calcaneal fractures in order to provide a reference for the clinical and reduce the incidence of incision complications.MethodRetrospective study 102 cases 117 feet of patients from department of orthopedics QuanZhou First Hospital Affiliated Of FuJian Medical University(Including The DongJie Department and The ChengDong Department)January 2013 to January 2017.All patients,Injury mechanism was Fell from a height,used the same Processing method in preoperatively and postoperatively among all patients,all patients were treated with lateral ankle fracture operation incision with L-type approach(Including traditional and improved L-type approach),Through the incision healing all patients were Divided into complications and non-complications group.The average time of follow-up was 18 months(6 months to 42 months),and Follow-up methods were divided into telephone follow-up and outpatient follow-up.The data we collected include Patient's gender and age,The fall height when injured,Surgery timing,incision type,the serum albumin value,hemorrhage during operation,operation time,smoking history and drinking history.The SPSS20.0 software is adopted to the above 10 factors may influence the postoperative incision healing to single factor analysis,the statistically significant factors for multiariable logistic regression analysis,P < 0.05 for the difference is statistically significant.ResultSingle factor analysis results: The fall height when injured,Surgery timing,incision type,the serum albumin value differences between four indexes such as group were statistically significant(P < 0.05),namely the four index is the influence factors of postoperative incision complications.But age,gender,hemorrhage during operation,operation time,smoking history and drinking history those six indicators were not statistically significant(P>0.05).Multivariate logistic regression analysis showed that: 1.The risk of postoperative incision complications was 2.605 times after the height of the fall increased 1m;2.The serum albumin content of the preoperative patients increased by 1g/L,and the risk of postoperative incision complications decreased to 0.659 times;3.The risk of incision complications in patients with improved "L" type incision was 0.091 times that of the traditional "L" type incision;4.Surgical operation was performed 1-6 after injury,the incidence of postoperative incision complications was the highest,followed by 13 to 18 days after injury,and the incidence of postoperative incision complications was the lowest within 7 to 12 days after the injury.Among them,the risk of incision complications occurred in 7 to 12 days after wound operation was 0.025 times of 1 to 6 days after injury,and the risk of incision complication after operation of 13 to 18 days after injury was 1 ~ 0.047 times in 6 days.Conclusion 1.The height of the fall is the risk factor of incision complication after closed calcaneal fractures.The higher the fall height,the greater the risk of postoperative incision complications.2.Preoperative hypoproteinemia is a risk factor for incision complications following closed calcaneal fractures.The risk of postoperative incision complications can be reduced by increasing serum albumin levels.3.The time interval between injury and operative time is the influencing factor of postoperative incision complications,the risk of surgical complications is greatest in 1 to 6 days after injury,Next is within 13 to 18 days after injury,lowest is within 7 to 12 days after injury.4.Using the traditional "L" lateral incision is a risk factor for the postoperative incision complications of closed and osseous fractures,and improved "L" lateral incision can reduce the incidence of postoperative incision complications.The occurrence of the complications is related to the distribution and shape of the lateral vessels of the bone,and the improved "L" lateral incision can avoid the vascular aberration and reduce the damage to the soft tissue blood supply.