锁定钢板螺钉内固定物取出困难原因分析及取出技巧

Causes for difficulty in removal of locking plate and screws and their handling skills

锁定钢板已被广泛应用于关节周围骨折、粉碎性及骨质疏松骨折固定，而临床内固定物取出时有发生，涉及锁定钢板取出困难的事件也逐渐增多。临床关注内固定物取出困难相关问题的研究报道较少。螺钉滑丝、螺纹错扣及冷焊接是导致锁定钢板螺钉取出困难的主要原因，目前报道的取出技术包括不需要特殊器械的简单实用技术和需要特殊器械的复杂技术。内固定物取出困难将会导致手术时间延长、二次更大创伤、金属碎屑残留等风险。预防是最有效的治疗方法。对导致锁定钢板及螺钉取出困难的原因分析及取出技术总结，将有助于骨科医师术中加以预防和应对。

As locking plate is widely used in periarticular and comminuted fractures as well as in fixation of osteoporotic bone, the events involving difficulty in removal of a locking plate increase gradually. Little re- search addresses the difficulty in implant removal. Stripping of the recess of the screw head, cross-threading between threads in the screw head and screw hole and cold welding are the main causes for difficulty in removing screws from a locking plate. Skills for implant removal include simple ones that require no use of special devices and complex ones that require use of special devices. Difficult implant removal will result in lengthened operation time, increased risk of secondary invasive surgery, residues of metallic shavings and so on. Prevention is the most effective countermeasure. This review summarizes the cause for difficult removal of locking plate and screws as well as the removinz skills to held orthopedic surgeons prevent and respond to the difficulties intraoperatively.