 机器翻译字幕，仅供参考： calcaneal fractures skin and soft tissue conditions 跟骨骨折 皮肤和软组织 状况 calcaneal fractures is an interesting topic and the calcaneus is known to have 跟骨骨折是一个有趣的 话题，众所周知，跟骨在手术后 a high rate of skin complications following surgery 有很高的皮肤并发症发生率 the skin at risk more when you have a displaced humerosity fracture or an 当您有 移位的肱骨骨折或舌型 avulsion fracture of the calcaneus 跟骨撕脱骨折时，皮肤风险更大 in tongue type fracture（舌型骨折） if the fracture is badly displaced then it may lead to 骨折如果 骨折移位严重，可能会导致 skin complication and the fracture need to be reduced urgently 皮肤并发症，骨折 需要紧急复位 tongue type fracture is known to do well with percutaneous reduction and fixation 众所周知，舌型骨折 经皮复位固定效果很好 in case of an evolution fracture of the calcaneus you need to reduce the ，以防跟骨发生骨折， 您需要复位 fracture urgently because it threatens the posterior skin 骨折 紧急，因为它威胁 到后部皮肤， delay in reduction of the fracture will compromise the skin and the soft tissue 延迟复位骨折会 损害后跟的皮肤和软组织 at the posterior heel this fracture occurs more in diabetics ， 这种骨折在糖尿病患者中发生率较高， if the fragment is large you may be able to do percutaneous fixation of the 如果骨折块较大，您可能 可以进行骨折的经皮固定 fracture surgical treatment of displaced 手术治疗 移位的 calcaneal fractures is associated with decrease in the risk of subteller 跟骨骨折与 亚型的风险降低有关 arthritis compared to non-surgical treatment 跟骨骨折的非手术 治疗 in calcaneal fractures young women do better if they have surgery 相比，年轻女性 如果接受手术治疗效果更好 the most common complication of calcaneal fracture surgery especially if 跟骨骨折手术最常见的并发症特别是 the injury is severe is wound complication and wound the essence 如果损伤严重是伤口 并发症和伤口 本质 superficial wound infection is common deep wound infection ranges from one to 浅表伤口感染是常见的 深部伤口感染范围从 1 four percent enclosed fractures % 到 4% 的封闭性骨折 the presence of associated miracle comorbidities affects wound healing such 相关的奇迹合并症的存在 会影响伤口愈合， as smoking diabetes and peripheral（ /pəˈrɪfərəl/adj. 外围的；次要的） vascular disease 例如吸烟 糖尿病 和外周血管疾病 these factors will compromise the skin healing and increase the surgical risk 这些因素会影响皮肤 愈合并增加手术风险 so if you have an older patient with inadequate circulation 因此，如果您有一位患有循环不足的老年患者 diabetes and smoking that patient may do better with conservative treatment 糖尿病并且该患者吸烟 保守治疗可能会更好 more complications will occur in sanders type 4 calcaneal fractures Sanders 4 型跟骨骨折会出现更多并发症 delayed fixation is often recommended depending on the condition of the soft 根据软组织的情况，通常建议 tissue delayed wound healing and wound dehiscence 延迟固定 伤口愈合延迟，伤口裂开 is the most common complication of surgical treatment of 是跟骨手术治疗最常见的 并发症 calcaneal fracture utilizing extension lateral approach 使用延伸 横向入路的 excessive approach may have delayed wound healing in about 20 percent of the 骨折 在大约 20% 的 cases the limited sinus society approach has less incidence of skin complications 病例中，过度入路可能会延迟伤口愈合 有限跗骨窦入路 的皮肤并发症发生率较低 each approach has its own advantage and disadvantage and each approach may 每种入路都有其自身的优点和 缺点，每种入路都可能 compromise a nerve in the vicinity of the approach as you can see here in this 损害附近的神经 正如您在此 diagram 图 in general surgery is delayed until the soft tissue condition improves and until 中所看到的，普通手术中的方法被推迟，直到 软组织状况改善， the wrinkle test is positive you see wrinkles in the foot and the ankle 直到皱纹测试呈阳性，您才会看到 脚和脚踝出现皱纹， but there is one situation where you don't want to delay the surgery and that 但在一种情况下，您 不想延迟 手术，这种 situation is when the fragment is displaced such as with an avulsion 情况是当骨折块 移位时，例如 fracture of the calcaneus or tongue type fracture that's badly displaced then you 跟骨撕脱性骨折或 严重移位的舌型骨折，那么您 need to do the surgery urgently otherwise the skin on the back of the 需要紧急进行手术， 否则如果您等待，脚后跟后部的皮肤 heel will be compromised if you wait that may lead to 将受到损害 可能导致 full thickness skin necrosis there's a very thin overlapping soft 全层皮肤坏死 tissue envelope in this area 在这个区域有一个非常薄的重叠软组织 patients with calcaneal fractures may also get compartment syndrome of the 包膜 如果忽视跟骨骨折的 nts 也可能患 foot if neglected it will lead to clutters 足部 due to contracture of the intrinsic flexural muscles in general if compartment syndrome develop then you need to do a fasciotomy（筋膜切开术）（fascia /ˈfeɪʃə/ 筋膜） 筋膜室综合征，如果发生筋膜室综合征，通常 会由于内在弯曲肌肉的挛缩而导致混乱，那么您需要对足部进行相位 of the foot and these are examples of the incisions used in phasiotomy of the 切开术，这些是切口的例子 用于足部切开术 foot remember there are nine compartments in 请记住，足部有 9 个隔室，手部有 10 个隔室， the foot and 10 in the hand so what are these nine compartments 那么这九个隔室是什么， one medial one lateral four intraoci 一个内侧， 一个外侧，四个眼 one adductor and two central surfacial and deep as you can see here in this 内，一个内收肌，两个中央表面 和深部，正如您在这张图表中看到的 diagram compartment syndrome of the foot can 隔室综合征 occur up to 10 percent of patients with severe calcaneal fractures 多达 10% 的严重跟骨骨折患者可能会出现足部 when compartment syndrome occurs especially when it is messed there will 当发生筋膜室综合征时， 尤其是当它被弄乱时，足部 be contractures of the intrinsic flexor muscles of the foot and that will create 固有屈肌会 挛缩，这会 glowing of the lesser toes this will create problem with wearing 导致小脚趾发光， 这会导致穿着问题 shoes the plantar fascia will limit the space 鞋 足底筋膜会限制 that's available for hematoma and swelling this will cause damage to the 可用于血肿和 肿胀的空间 会对足部内在屈肌造成损伤， intrinsic flexor muscles of the foot that's why fasciatomy is very important 这就是为什么筋膜切开术非常重要 open fractures of the calcaneus will have significant complications 跟骨的开放性骨折将 有严重的并发症 open reduction and internal fixation is not recommended for grade 3 medial 对于 3 级内侧 wounds or for most of lateral wounds with open fractures there is a high 伤口或大多数开放性骨折的外侧伤口 ，不建议切开复位和内固定 incidence of wound complications including amputations 伤口并发症的发生率很高， 包括截肢 if it is grade 1 or grade 2 open fracture medially you can do surgical 如果是 1 级或 2 级 开放性骨折，您可以进行 repair bilateral approach because the fracture is opened medially 双侧手术修复，因为 骨折是在内侧打开的 there will be no significant difference between infection rate for this fracture ，这种骨折的感染率与类似骨折的感染率没有显著性差异 and for a similar one that is a closed fracture 是闭合性骨折 give the patient antibiotics after surgery for two to three days 手术后给予患者抗生素两到三天， but open injuries conservative treatment may be advisable in this situation 但 在这种情况下， if the soft tissue condition does not allow oven reduction internal fixation 如果软组织状况 不允许烤箱复位内固定， even on a delayed basis the conservative treatment may be the best option 即使在延迟的基础上，保守 治疗可能是最好的。 available 可用的选项 thank you very much i hope that was helpful 非常感谢你我希望 w 对你有帮助 you
|
|
|
