مقايسه اثر دوختن و ندوختن زير جلد در ايجاد عوارض زخم بعد از جراحي هاي هيپ در بيمارستان سينا طي سالهاي 1390 تا 1392

Comparison of Subcutaneous Tissue Closure versus Non Closure after Hip Surgery in Sina Hospital from 2011 to 2013

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﻏﻠﺐ ﺗﻮﺻﻴﻪ ﻣﻲﺷﻮﺩ ﮐﻪ ﭘﺲ ﺍﺯ ﺍﻧﺠﺎﻡ ﻋﻤﻞ ﺍﺻﻠﻲ ﻭ ﺩﻭﺧﺘﻦ ﻓﺎﺷﻴﺎ، ﺯﻳﺮ ﺟﻠﺪ ﺑﺎ ﻧﺦﻫﺎﻱ ﻗﺎﺑﻞ ﺟﺬﺏ ﺗﺮﻣﻴﻢ ﻣﻲﺷﻮﺩ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪﻑ ﻣﻘﺎﻳﺴﻪ ﭘﻴﺎﻣﺪﻫﺎﻱ ﺣﺎﺻﻞ ﺍﺯ ﺟﺮﺍﺣﻲﻫﺎﻱ ﻫﻴﭗ ﻫﻤﺮﺍﻩ ﺑﺎ ﺑﺨﻴﻪ ﺯﻳﺮ ﺟﻠﺪﻱ ﺑﺎ ﻣﻮﺍﺭﺩﻱ ﮐﻪ ﺍﺯ ﺗﺮﻣﻴﻢ ﺯﻳﺮ ﺟﻠﺪ ﺻﺮﻑ ﻧﻈﺮ ﺷﺪﻩ ﺍﻧﺠﺎﻡ ﻣﻲﺷﻮﺩ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺷﻴﻮﻩ ﮐﺎﺭﺁﺯﻣﺎﻳﻲ ﺗﺼﺎﺩﻓﻲ ﺑﺎﻟﻴﻨﻲ ﻳﮏ ﺳﻮ ﮐﻮﺭ ﻃﻲ 2 ﺳﺎﻝ ﺑﺮ ﺭﻭﻱ ﮐﻠﻴﻪ ﺑﻴﻤﺎﺭﺍﻥ ﮐﺎﻧﺪﻳﺪ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻫﻴﭗ ﻣﺮﺍﺟﻌﻪ ﮐﻨﻨﺪﻩ ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺳﻴﻨﺎ ﻛﻪ ﻧﻴﺎﺯﻱ ﺑﻪ ﺑﺎﺯ ﮔﺬﺍﺷﺘﻦ ﺯﺧﻢ ﻭ ﺗﺮﻣﻴﻢ ﺛﺎﻧﻮﻳﻪ ﺁﻥ ﻧﺪﺍﺷﺘﻨﺪ، ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﻭ ﻣﻮﺍﺭﺩﻱ ﻛﻪ ﮔﺮﺍﻓﺖ ﻭ ﻓﻼﭖ ﭘﻮﺳﺘﻲ ﻭ ﻳﺎ ﻋﻀﻼﻧﻲ ﭘﻮﺳﺘﻲ ﻣﻮﺭﺩ ﻧﻴﺎﺯ ﻧﺒﻮﺩ، ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. ﺑﻴﻤـﺎﺭﺍﻥ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺟﺪﻭﻝ ﺍﻋﺪﺍﺩ ﺗﺼﺎﺩﻓﻲ ﺑﻪ ﺩﻭ ﮔﺮﻭﻩ ﺍﺻﻠﻲ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﺩﺭ ﻳﮏ ﮔﺮﻭﻩ ﻓﺎﺷﻴﺎ ﻭ ﺯﻳﺮ ﺟﻠﺪ ﺩﻭﺧﺘﻪ ﺷﺪ ﻭ ﺳﭙﺲ ﭘﻮﺳﺖ ﺑﺎ ﻧﺦ ﻧﺎﻳﻠـﻮﻥ ﺑﺨﻴﻪ ﺯﺩﻩ ﺷﺪ )48 = N(. ﺩﺭ ﮔﺮﻭﻩ ﺩﻭﻡ ﺗﻨﻬﺎ ﭘﻮﺳﺖ ﻭ ﻓﺎﺷﻴﺎ ﺩﻭﺧﺘﻪ ﺷﺪ )52 = N(. ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﻫﻔﺘﻪ 1 ﻭ 2 ﻭ ﻣﺎﻩ 1 ﻭ 3 ﺍﺯ ﻧﻈﺮ ﻋـﻮﺍﺭﺽ ﺍﺣﺘﻤﺎﻟﻲ ﻋﻔﻮﻧﺖ، ﺑﺎﺯﺷﺪﻥ ﺯﺧﻢ، ﻭﺍﻛﻨﺶ ﺟﻠﺪﻱ، ﻧﻜﺮﻭﺯ ﻟﺒﻪﻫﺎﻱ ﭘﻮﺳﺖ ﻭ ﺗﺠﻤﻊ ﻣﺎﻳﻊ ﺯﻳﺮ ﺟﻠﺪﻱ( ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺎﻧﮕﻴـﻦ ﻣـﺪﺕ ﺯﻣﺎﻥ ﻋﻤﻞ ﺟـﺮﺍﺣﻲ ﺩﺭ ﮔـﺮﻭﻩ ﺑﺎ ﺑﺨﻴﻪ ﺯﻳﺮﺟﻠـﺪﻱ ﺑﻴﺸﺘﺮ ﺍﺯ ﮔﺮﻭﻩ ﺑﺪﻭﻥ ﺑﺨﻴﻪ ﺯﻳﺮ ﺟﻠﺪﻱ ﺑﻮﺩﻩ ﺍﺳﺖ )15/095 ± 113/04 ﺩﺭ ﺑﺮﺍﺑﺮ 105/38±14/776 ﺩﻗﻴﻘﻪ، 0/012 = P. ﺩﺭ ﻣﻮﺭﺩ ﺳﺎﻳﺮ ﻋﻮﺍﺭﺽ ﻣﺜﻞ ﻧﮑﺮﻭﺯ ﻟﺒﻪ ﭘﻮﺳﺖ، ﺑﺎﺯ ﺷﺪﻥ ﺯﺧﻢ، ﺗﺠﻤﻊ ﻣﺎﻳﻊ ﺯﻳﺮ ﺟﻠﺪ ﺗﻔﺎﻭﺕ ﻣﻌﻨﻲﺩﺍﺭﻱ ﺑﻴﻦ ﺩﻭ ﮔﺮﻭﻩ ﻧﺒﻮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺩﺭ ﻧﻬﺎﻳﺖ ﺍﻳﻨﮑﻪ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺑﺨﻴﻪ ﺯﻳﺮﺟﻠﺪﻱ ﻧﻪ ﺗﻨﻬﺎ ﺩﺭ ﮐﺎﻫﺶ ﻋﻮﺍﺭﺽ ﺯﺧﻢ ﺑﻌﺪ ﺍﺯ ﺑﺮﺵ ﺟﺮﺍﺣﻲ ﺗﺄﺛﻴﺮ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪﺍﻱ ﻧﺪﺍﺭﺩ ﺑﻠﮑﻪ ﻣﻮﺟﺐ ﺍﻓﺰﺍﻳﺶ ﻣﺪﺕ ﺯﻣﺎﻥ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻧﻴﺰ ﻣﻲﺷﻮﺩ.

Introduction & Objective: Wound complication is one of the most common problems after surgical incisions. The aim of this study was the evaluation of wound complications with subcutaneous tissue closure versus non closure after hip surgery. Materials & Methods: 100 patients who were candidates for hip surgery, from 2011 to 2013, were entered in this study. The patients randomly divided into two groups: Group 1, patients with subcutaneous closure (n=48) and group 2, patients without subcutaneous closure (n=52). Wound complications such as hematoma, necrosis, dehiscence, infection and scar were evaluated. Patients were seen in first, second, fourth and eighth weeks after operation. Statistical analysis was done with SPSS 16 by chi-squared and independent sample t-test. Results: In 100 patients, the mean age (55±18.009) year and mean weight (75.41±10.007) kg were not significantly different between the two groups. 56 patients were men and 44 of patients were women. Sex was not significantly different between two groups (P=0.652).One person had diabet mellitus and one had psoriasis. Of 100 surgical operations two were urgent. Of 100 patients 48 were operated with DHS fixatin, 16 hemi and total hip arthroplasty and 4 with osseous resection. 20 had femoral IM and 12 had fracture of acetabulum. Surgical technique was not significantly different between the two groups (P=0.958) .We found hematoma in 2 patients and inflammation in 3 patients. Dehiscence was not detected in anybody. Wound infection was found in 3 persons. As a whole no complication was significantly different between the two groups. The mean operation time in the first group was 113±15 minute and in second group was 105 ±14 minute. The first group’s operation time was significantly more than second group (P=0.012). The mean incisional length in first group (11.88±3cm) was significantly more than second group (9.88±3cm), (P=0.004). Conclusions: Our study showed that subcutaneous closure, not only has no significant role on wound complication reduction, but also makes patients to tolerate longer surgical operation.