医用金属碎屑吸附装置的研制与临床应用

MANUFACTURE AND CLINICAL APPLICATION OF MEDICAL METAL DEBRIS ADSORPTION APPARATUS

目的介绍一种医用金属碎屑吸附装置并探讨其在锁定钢板内固定取出术中的应用价值。方法2011年1月-2013年5月,对83例患者行锁定钢板内固定取出术。男44例,女39例;年龄21-59岁,平均35.4岁。内固定取出术距骨折内固定术时间为16-40个月,平均22.6个月。其中9例（32枚）锁定螺钉滑扣取出困难,采用锰钢钻打磨锁定螺钉尾帽和螺纹的方法,使钢板和螺钉分离后取出;打磨过程中,4例（16枚）使用医用金属碎屑吸附装置（A组）,5例（16枚）未使用（B组）。比较两组手术时间、滑扣螺钉单钉取出时间、术中出血量及金属碎屑残留量评分,记录术后并发症发生情况。结果术中共拆除锁定螺钉658枚,其中滑扣螺钉32枚,总滑扣率为4.86%。3.5mm及4.5mm或5.0mm锁定螺钉滑扣率分别为6.53%、2.31%,内固定时间〈2年及〉2年的锁定螺钉滑扣率分别为3.21%、6.08%。A组手术时间、滑扣螺钉单钉取出时间、术中出血量及金属碎屑残留量评分均显著低于B组,差异均有统计学意义（P〈0.05）。B组术中1例发生再骨折、术后1例发生切口感染,A组无相关并发症发生。两组患者术后随访8-35个月,平均23.4个月,随访期间均无异位骨化发生。结论锁定钢板取出术中取出滑扣螺钉时,使用医用金属碎屑吸附装置能明显缩短手术时间,减少金属碎屑残留和术中出血量。

Objective To introduce a medical metal debris adsorption apparatus and to discuss the application value in removal of locking plate internal fixation. Methods Between January 2011 and May 2013, 83 cases underwent removal of locking plate fixation. There were 44 males and 39 females, aged 21-59 years（mean, 35.4 years）. The time from the i rst operation to internal fixation removal was 16-40 months（mean, 22.6 months）. Thirty-two screws of 9 patients were removed dii cultly due to slide fastener. The screws were removed eventually after plates and screws were separated by grinding locking screw with manganese steel drill. In the process of grinding, the medical metal debris adsorption apparatus was used in 16 screws of 4 patients（group A）, and was not used in 16 screws of 5 patients（group B）. The operation time, removal time of single slipping screw, intraoperative blood loss, and the score of metal debris residues were compared between 2 groups. And the postoperative complications were recorded. Results A total of 658 screws were removed, and 32 slipping screws were found, accounting for 4.86%. The lock screw slipping rates of 3.5 mm and 4.5 or 5.0 mm respectively were 6.53% and 2.31%; and the lock screw slip ping rates of internal fixation time 〈2 years and 〉2 years respectively were 3.21% and 6.08%. The operation time, removal time of single slipping screw, intraoperative blood loss, and the score of metal debris residues of group A were significantly lower than those of group B（P〈0.05）. Re-fracture（1 case） and incision infection（1 case） occurred in group B, and no complication was observed in group A. The cases of 2 groups were followed up 8-35 months（mean, 23.4 months）. No heterotopic ossii cation occurred in both groups during the follow-up. Conclusion The medical metal debris adsorption apparatus can significantly shorten the operation time, reduce the residual metal debris and surgical bleeding when removing the slipping screws in removal of locking plate internal fixation.