影响四肢骨折患者手术愈合后内固定装置取出困难的危险因素分析及干预对策

Analysis of risk factors relarelating to difficulty in removing internal fixation device inting patients with limb frafractures after surgery and its countermeasuresctures

背景:四肢骨折是临床上较为常见的骨折。内固定手术治疗是其常用治疗方式。但术后会出现内固定装置取出困难的问题。目的:分析影响四肢骨折患者手术愈合后内固定装置取出困难的危险因素,并提出干预对策。方法:回顾性分析2013年9月至2015年6月在我院行内固定手术治疗的168例四肢骨折患者的临床资料,其中40例出现手术愈合后内固定装置取出困难现象。统计并分析临床资料中影响四肢骨折患者手术愈合后内固定装置取出困难的可能危险因素,并采用多元Logistic回归分析危险因素。结果:内固定装置取出困难的发生率为23.81%(40/168)。单因素分析显示,性别、内固定装置取出时间、骨痂生长等因素可能与内固定装置取出困难不相关(P>0.05),而年龄、患肢过早负重、螺钉旋入时扭力过大、接骨板紧贴程度、术中植骨等因素可能与内固定装置取出困难相关(P<0.05)。多元Logistic回归分析结果显示,危险因素由高到低依次为术中植骨不充分(OR=5.423)、螺钉旋入时扭力过大(OR=4.678)、接骨紧贴过度(OR=3.982)、患肢过早负重(OR=2.510)和年龄≥60岁(OR=1.525)。结论:手术愈合后内固定装置取出困难影响因素较多,应从这些因素综合考虑,以降低内固定装置取出困难的发生率。

Background： Limb fractures are common in clinic. Internal fixation is the most common treatment. However, difficulty in removing internal fixation device may occur after the operation. Objective： To analyze the risk factors relating to difficulty in removing internal fixation device in patients with limb fractures after surgery, and to perform the intervention countermeasures. Methods： The clinical data of 168 patients with limb fractures treated with internal fixation in our hospital from September 2013 to June 2015 were retrospective analyzed. It was difficult to remove internal fixation device in 40 of them after surgery. The risk factors that would affect removal of internal fixation device were selected out and analyzed by multiple Logistic regression analysis. Results： The incidence of difficult removal was 23.81%（40/168）. The single factor analysis showed that there was no significant difference in gender, removal time of internal fixation device, or callus growth（P〉0.05）, patient＇s age, early weight-bearing, excessive torque when screwing, bone graft and plate were related to the difficult removal（P〈0.05）. The multiple Logistic regression analysis showed that the factors were ranked by the risk degrees from high to low as follows： the insufficient bone graft during operation（OR=5.423）, screwed into the excessive torque（OR=4.678）, excessively close to plate（OR=3.982）, early weight-bearing（OR=2.510） and age greater than or equal to 60 years old（OR=1.525）. Conclusions： There are many factors affecting removal of internal fixation device in patients with limb fractures after surgery, which should be considered comprehensively in order to reduce the incidence rate of difficult removal of internal fixation device.