Abstract: Objective To investigate the related factors of chronic swelling of the foot during the rehabilitation period after the treatment of closed calcaneal fractures in the young and middle-aged with "L" -shaped incision, and to provide references for clinical improvement of the prognosis of calcaneal fractures. Methods All patients with closed calcaneal fractures who met the selection criteria and were treated with traditional "L"-shaped approach surgery in the Department of Lower Extremity Traumatology and Orthopedics of Heyuan City Hospital of Traditional Chinese Medicine from September 2017 to December 2020 were selected, including 42 males and 18 females, 25 cases of 15-44 years old and 35 cases of 45-59 years old. Among them, patients suffered from foot swelling 6 weeks after the operation were regarded as a swelling group, and patients without foot swelling as a non-swelling group. Based on the data of the two groups, the analysis and discussion were carried out. Based on patients' follow-up data, the factors that might affect chronic swelling of the foot after calcaneal fracture surgery were selected, including patients' age, gender, body mass index, smoking, and other general conditions, as well as fracture classification, surgical conditions, and early postoperative wound healing. χ2 test was used and multivariate logistic stepwise regression analysis was performed based on the univariate analysis results to screen out the related factors of chronic swelling of foot after calcaneal fracture surgery. Results A total of 60 patients were enrolled, including 45 patients in the swelling group and 15 patients in the non-swelling group. Logistic regression analysis showed that usage time of tourniquet over 80 min, type Ⅳ fracture, poor fracture reduction quality, and wound complications were related factors of chronic swelling of the foot during the rehabilitation period after the treatment of closed calcaneal fractures with "L" -shaped approach surgery (all OR>1, P<0.05). Conclusions In the clinical treatment of young and middle-aged patients with closed calcaneal fractures through the traditional "L" -type approach, foot swelling is likely to occur during the postoperative rehabilitation period. Further analysis of related factors has found out that the intraoperative tourniquet used for a long time, the degree of injury as serious as type Ⅳ fracture, poor fracture reduction, and wound complications are the main factors. By circumventing these factors during the perioperative period, the incidence of foot swelling during the postoperative rehabilitation period can be greatly reduced.

Key words: "L" -shaped incision, Closed calcaneal fractures in the young and middle-aged, Postoperative rehabilitation period, Swelling of the affected foot, Related factors

摘要： 目的 探讨“L”形切口治疗中青年闭合性跟骨骨折术后康复期患足慢性肿胀的相关因素，为临床改善跟骨骨折预后提供参考。方法 选取所有符合入选标准的2017年9月至2020年12月时间段就诊于河源市中医院下肢创伤骨科并行传统“L”型入路手术治疗的闭合性跟骨骨折患者，男 42例、女18例，15～44岁25例、45～59岁35例。其中术后6周患足仍肿胀患者作为肿胀组，术后6周患足消肿患者为无肿胀组，以此两组患者数据为基础进行分析探讨。依据患者随访资料，选取可能影响跟骨骨折术后足部慢性肿胀的因素，包括患者年龄、性别、体质量指数、吸烟等一般情况，以及骨折分型、手术情况、术后早期伤口愈合情况等，应用统计学方法进行χ2 检验，并根据单因素分析结果纳入多因素logistic逐步回归分析，以筛选出影响跟骨骨折术后患足慢性肿胀的相关因素。结果 共纳入60例患者，其中肿胀组45例、无肿胀组15例。logistic回归分析发现，影响“L”型入路闭合性跟骨骨折 患者术后康复期患足肿胀的相关因素为术中止血带使用时间>80 min、Ⅳ型骨折、骨折复位质量差、伴伤口并发症（均OR>1，P<0.05）。结论 临床通过传统“L”型入路术式治疗中青年闭合性跟骨骨折患者，术后康复期易发生患足肿胀，且进一步分析相关因素发现术中止血带使用时间久、损伤程度重如Ⅳ型骨折、骨折复位欠佳、伤口并发症是主要因素，围术期通过规避上述因素可大大降低术后康复期患足肿胀的发生率。

关键词: “L”形切口, 中青年闭合性跟骨骨折, 术后康复期, 患足肿胀, 相关因素