章氏超减张缝合Pilon骨折高张力切口

Zhang's tension-reduced suture for high tension incision for Pilon fracture

摘要:

[目的] 介绍章氏超减张缝合技术在 Pilon 骨折高张力切口中的应用和初步临床效果。[方法] 2019—2022 年收治的 Pilon 骨折中 11 例高张力切口应用章氏超减张缝合。该缝合方法进针点分列切口两侧，与切口轴向间距约 1 cm；起始点及终止点分别位于切口延长线两端，距离切口约 1 cm。于切口一端起始点自皮下垂直进针，顺序穿经皮下组织、真皮层、 表皮层并出针，再由同一点自皮肤表面垂直进针，顺序穿经表皮层、真皮层、皮下组织，适度拉紧皮肤组织后于皮肤表面穿皮点处形成凹陷，连续缝合至切口另一端，于终点皮下打结。[结果]所有患者均一期闭合切口，11 例中 10 例切口甲级愈合，1 例切口愈合不良，二期扩创后愈合，无感染、皮瓣坏死。随访时间平均（13.5±3.2）个月。末次随访时 AOFAS 踝-后足评分平均 （85.3±4.4）分，其中优 6 例，良 3 例，可 2 例。[结论]章氏超减张缝合法可以一期关闭高张力 Pilon 骨折切口，能有效降低切口并发症。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of Zhang's tension-reduced sutures for high-tension incision secondary to open reduction and internal fixation (ORIF) of Pilon fracture. [Methods] A total of 11 patients had incisions closed by this tension-reduced suture following ORIF of Pilon fractures from 2019 to 2022. The enter points of the suture were separated on both sides of the incision, with distance from the incision edge about 1cm. The starting point and the ending point were located at both ends, about 1cm away from the incision. At one end of the incision, the needle was vertically inserted into the subcutaneous tissue, dermis and epidermis in order to exit the needle; at the same point, the needle was vertically inserted into the skin surface in order to penetrate the epidermis, dermis and subcutaneous tissue, and the skin surface to form a depression at the puncture point after moderately tightening the skin tissue, and was continuously stitched to the other end of the incision, and the subcutaneous knot was tied at the end. [Results] This Zhang's tension-reduce suture can close the high-tension after ORIF of Pilon fracture in one-stage, and can effectively reduce the complication of the incision.