拆钢板致再骨折原因分析及对策

目的分析拆钢板困难时用非常规方法强拆致术中再骨折，或钢板拆除后无外伤再骨折的原因，探讨再骨折的处理对策。方法回顾性分析2012年6月至2017年3月拆钢板术中或术后再骨折的114例患者的临床资料，因螺钉滑丝铜板拆除困难6例，采用大力剪剪断钢板、钨钢钻磨掉螺钉尾部撬拔钢板、扩孔取螺钉等方法，术中发生骨折4例，术后无外伤2d内骨折2例；铜板顺利拆除，术后无外伤10d内骨折5例，均因为骨折未愈合或未完全愈合。再骨折部位：锁骨中段6例，尺骨中段1例，桡骨中下段2例，肱骨中上段1例，肱骨中下段1例。根据发生再骨折的原因，对术中再骨折的4例患者即刻重新内固定，其中2例取髂骨植骨；术后再骨折7例患者中，予植骨、内固定4例，保守治疗3例。结果11例患者骨折愈合10例，1例锁骨再骨折予保守治疗仍来愈合，因为功能影响不大，患者放弃进一步治疗。结论拆除内固定前要仔细检查，明确患者骨折愈合的状况，术中内固定取出困难时，尽量采用无损伤或损伤较小的方法，重视与患者及家属的沟通，做好再骨折的预防。

Objective To analyze the intraoperative refracture caused by plate removal with unconventional method, or the postoperative refracture without trauma, and discuss the treatment of refracture. Methods 11 patients with refracture of plate removal were selected between June 2010 and March 2017.6 cases were difficult to remove the plate caused by screw slide wire. 4 cases occurred intraoperative refracture with unconventional method, and 2 cases occurred postoperative refracmre within 2d without trauma. When the plate was removed successfully, 5 cases occurred refracture within 10d without trauma, all of which were caused by unhealed or incomplete healing of the fracture. According to the position ofrefracture： 6 cases in the middle clavicle, 1 case in the middle of ulna, 2 cases in the middle and lower radius, 1 case in the nfiddle and upper humerus, and l case in the middle and lower humerus. According to the reason of the refracture, 4 patients of intraoperative refracture were immediately refixed, 2 of whom received iliac bone grafting. Among the 7 cases of postoperative refracture, 4 cases were treated with bone grafting and internal fixation, and 3 cases were treated conservatively. Results 10 cases ofrefracture were healing and 1 case of clavicular refracture remained unhealed after conservative treatment, and the patient gave up further treatment because the function had little impact. Conclusioas Before dismantling internal fixation, careful examination should be made to clarify the condition of the fracture healing of the patients. When the internal fixation is difficult, we should try to use the method of no injury or minor injury, attach importance to the communication with the patients and their families, and do a good job in the prevention of the re-fracture