骨折内固定装置移除的影响因素研究

Study on the factors influencing the removal of internal fixation device for fracture

目的探讨骨折内固定装置移除的影响因素,为临床治疗提供循证医学依据。方法回顾性分析2016年1月至2017年12月309例在我院行内固定装置移除手术患者的临床资料,其中上肢骨折105例,下肢骨折204例。根据患者的病历记录统计内固定装置移除术中出现移除困难的发生率,同时记录患者年龄、内固定系统在体内留存的时间以及内固定系统的固定方式(包括锁定螺钉的直径、位置、置入方式、固定皮质数及锁定螺钉与接骨板是否垂直等因素),分析上下肢内固定装置移除困难的主要原因。结果上肢骨折的患者中,15例患者出现内固定装置移除困难,以肱骨远端骨折的发生率最高(38.46%);患者的年龄(P=0.022)、内固定物留存体内的时间(P=0.001)是固定物移除困难的独立危险因素。下肢骨折的患者中,23例患者出现移除困难,以股骨近端骨折的发生率最高(37.50%);螺钉的直径(P=0.020)以及螺钉的置入方式(P=0.000)是固定物移除困难的独立危险因素。结论对于不同骨折部位的患者,术中应充分考虑并选择合适数量和类型的螺钉;若术后需要移除内固定装置,应当尽早进行手术。

Objective To study the factors influencing the removal of internal fixation device for fracture.Methods Clinical data of 309 patients with limb fractures who underwent internal fixation device removal in our hospital were retrospectively analyzed,including 105 cases of upper limb fractures and 204 cases of lower limb fractures.According to the patient's medical records,the incidence of difficulty in removing the internal fixation during the operation was calculated.Meanwhile,the patient's age,the retention time of the internal fixation system,and the fixation mode of the internal fixation system were recorded(including the diameter,position,placement mode,number of cortical fixation and whether the locking screw was perpendicular to the bone plate),so as to analyze the main reasons of the difficulty in removing the internal fixation devices of upper and lower limbs.Results Among the patients with upper limb fractures,15 patients had difficulty in removing internal fixation devices,with the highest incidence of distal humerus fractures(38.46%).The age of patients(P=0.022)and the retention time of the internal fixation system(P=0.001)were independent risk factors for the difficulty in removing the internal fixation.Among the patients with lower limb fractures,23 patients had difficulty in extraction,with the highest incidence of proximal femur fracture(37.50%).The diameter of the screw(P=0.020)and the method of screw placement(P=0.000)were independent risk factors for the difficulty in removing the internal fixation.Conclusion For patients with different fracture sites,the appropriate amount and type of screws should be considered and selected during the operation.If the internal fixation needs to be removed postoperatively,surgery should be performed as soon as possible.