锁定钢板上螺钉取出困难的解决方法及注意事项

Solution to the Problem of Screw Removal on the Locking Plate and Precautions

目的总结锁定钢板上螺钉取出困难的解决方法及注意事项。方法回顾性分析2015年3月-2019年1月90例锁定钢板螺钉术中取出困难的患者临床资料,其中,1枚螺钉取出困难24例,2枚及以上取出困难50例,术前术中螺钉断裂16例。男55例,女35例;年龄17~70岁,平均37.8岁。结果 4例钢板螺钉部分取出,86例钢板螺钉完全取出,切口I期愈合84例,延期愈合6例,医源性骨折、神经损伤各1例,无1例感染患者。结论锁定钢板上螺钉取出困难的原因复杂,掌握每种方法的适应证是关键,同时也要重视详尽的术前准备、认真的操作细节。切忌技术胜过理性,合理放弃也不失是一种保护性的选择。

Objective To summarize the solutions and precautions for the difficulty of screw removal on the locking plate. Methods The clinical data of 90 patients who had difficulty in removing the locking plate screws from March 2015 to January 2019 were retrospectively analyzed. Among them, 24 cases were difficult to remove one screw, 50 cases were difficult to remove 2 or more, and the oper-ation was performed before operation. The screw was broken in 16 cases. There were 55 males and 35 females;the age ranged from 17 to 70 years, with an average of 37.8 years. Results Four cases of plate screws were removed, 86 cases of plate screws were completely removed, 84 cases of incision were healed in stage I, 6 cases were delayed healing, 1 case of iatrogenic fracture and nerve injury, and no case of infection. Conclusion The reasons for the difficulty in removing the screws on the locking plate are complicated. It is the key to grasp the indications of each method. At the same time, it is necessary to pay attention to detailed preoperative preparation and careful operation details. Avoiding technology is better than rationality, and reasonable abandonment is also a protective choice.