骨凿撬动方法在螺钉滑牙锁定钢板取出中的应用
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摘要
[目的]介绍一种骨凿撬动取出螺钉滑牙锁定钢板的技术方法。[方法]回顾分析本院2015年1月～2018年1月行四肢锁定钢板内固定取出术中发生锁定螺钉滑牙27例患者的临床资料,男15例,女12例,年龄16～70岁,术中滑牙螺钉枚数:1枚21例,2枚5例,3枚1例。术中先取出其他未滑牙螺钉,清除钢板周围骨痂后,骨凿松动钢板与骨面。通过各个方向反复轻柔的撬动,使钢板与骨面逐步分离,经过反复撬动后,钢板逐步退出,大部分螺纹撬出骨面,取出钢板与螺丝钉。[结果]27例均采用同一方法将锁定螺钉及钢板完整取出,未发生医源性损伤,手术时间40～180 min,手术出血量均少于100 ml。术后早期切口均Ⅰ期愈合,无创面感染。患者均获随访,随访时间5～40个月,术后晚期无再骨折、骨髓炎、关节僵硬发生。[结论]骨凿撬动方法在四肢螺钉滑牙锁定钢板取出困难时是一种简便可行、适应证范围宽的手术方法。
[Objective] To introduce the technique of levering up with a bone chisel for removal of locking plate with stripped screw. [Methods] A retrospective summary was conducted on 27 patients who got a damaged screw head during removal the locking plate in our hospital from January 2015 to January 2018. The patients, including 15 males and 12 females aged 16-70 years, had 1 screw head damaged in 21 cases, 2 screws stripped in 5 cases and 3 screws stripped in 1 case. After the stripped screw identified, all the normal screws were removed first, the bone callus around the plate was taken away, and then the interface between the plate and bone surface was released. Subsequently, a bone chisel was inserted into the interface, levering up the plate with the chisel was gently performed. As prying force applied under the plate continuously,the stripped screw was gradually pulled out. Eventually, the implants were totally removed. [Results] All the 27 patients had the screws and plates removed completely without any iatrogenic injury. The operation time lasted for 40-180 min, associated with blood loss of less than 100 mL. All the patients achieved primary incisions healing without infection. During follow-up period ranged 5-40 months, no complications, such as postoperative refracture, osteomyelitis, and ankylosis occurred in anyone of them. [Conclusion] This bone chisel prying technique is a simple and feasible method with wide indications for the difficult removal of locking plate with stripped screw.
[Objective] To introduce the technique of levering up with a bone chisel for removal of locking plate with stripped screw. [Methods] A retrospective summary was conducted on 27 patients who got a damaged screw head during removal the locking plate in our hospital from January 2015 to January 2018. The patients, including 15 males and 12 females aged 16-70 years, had 1 screw head damaged in 21 cases, 2 screws stripped in 5 cases and 3 screws stripped in 1 case. After the stripped screw identified, all the normal screws were removed first, the bone callus around the plate was taken away, and then the interface between the plate and bone surface was released. Subsequently, a bone chisel was inserted into the interface, levering up the plate with the chisel was gently performed. As prying force applied under the plate continuously,the stripped screw was gradually pulled out. Eventually, the implants were totally removed. [Results] All the 27 patients had the screws and plates removed completely without any iatrogenic injury. The operation time lasted for 40-180 min, associated with blood loss of less than 100 mL. All the patients achieved primary incisions healing without infection. During follow-up period ranged 5-40 months, no complications, such as postoperative refracture, osteomyelitis, and ankylosis occurred in anyone of them. [Conclusion] This bone chisel prying technique is a simple and feasible method with wide indications for the difficult removal of locking plate with stripped screw.
引文
[1]张功林,葛宝丰.锁定钢板国外应用进展[J].中国骨伤,2009,22(8):643-645.
[2]Christen Sen FB,DalsLra M,Sejling F,et al.Titanium-alloy enhances bone-pedicle screw fixation:mechanical and histomorphometerical results of titanium-alloy versus stainless steel[J].Eur Spine J,2000,9(1):97.
[3]宋文奇,陈宇杰,罗从风,等.四肢内固定取出术并发症和意外分析及防治要点[J].中国骨与关节损伤杂志,2008(8):649-651.
[4]Bae JH,Oh JK,Oh CW,et al.Technical difficulties of removal of locking screw after locking compression plating[J].Arch Orthop Trauma Surg,2009,129(1):91-95.
[5]Kim SJ,Kim MU.A simple technique for removing a locking compression plate with a stripped locking screw[J].J Orthop Trauma,2012,26(1):51-53.
[6]Iwata T,Nozawa S,Maeda M,et al.New technique for removal of screws with damaged heads[J].Orthopedics,2017,40(5):911-914.
[7]Gupta R,Singh H,Singh A,et al.Hollow mill for extraction of stripped titanium screws:an easy,quick,and safe technique[J].JSurg Tech Case Rep,2014,6(1):9-11.
[8]Gopinathan NR,Dhillon MS,Kumar R.Surgical technique:simple technique for removing a locking recon plate with damaged screw heads[J].Clin Orthop,2013,471(5):1572-1575.
[9]Kumar G,Dunlop C.Case report:a technique to remove a jammed locking screw from a locking plate[J].Clin Orthop,2011,469(2):613-616.
[10]朱敏,徐永清,丁晶,等.一种取滑丝螺钉的方法[J].中国骨与关节损伤杂志,2012,27(5):475.
[11]殷渠东,顾三军,孙振中,等.钢板上螺钉取出困难的处理策略[J].中国修复重建外科杂志,2015,29(2):141-144.
[2]Christen Sen FB,DalsLra M,Sejling F,et al.Titanium-alloy enhances bone-pedicle screw fixation:mechanical and histomorphometerical results of titanium-alloy versus stainless steel[J].Eur Spine J,2000,9(1):97.
[3]宋文奇,陈宇杰,罗从风,等.四肢内固定取出术并发症和意外分析及防治要点[J].中国骨与关节损伤杂志,2008(8):649-651.
[4]Bae JH,Oh JK,Oh CW,et al.Technical difficulties of removal of locking screw after locking compression plating[J].Arch Orthop Trauma Surg,2009,129(1):91-95.
[5]Kim SJ,Kim MU.A simple technique for removing a locking compression plate with a stripped locking screw[J].J Orthop Trauma,2012,26(1):51-53.
[6]Iwata T,Nozawa S,Maeda M,et al.New technique for removal of screws with damaged heads[J].Orthopedics,2017,40(5):911-914.
[7]Gupta R,Singh H,Singh A,et al.Hollow mill for extraction of stripped titanium screws:an easy,quick,and safe technique[J].JSurg Tech Case Rep,2014,6(1):9-11.
[8]Gopinathan NR,Dhillon MS,Kumar R.Surgical technique:simple technique for removing a locking recon plate with damaged screw heads[J].Clin Orthop,2013,471(5):1572-1575.
[9]Kumar G,Dunlop C.Case report:a technique to remove a jammed locking screw from a locking plate[J].Clin Orthop,2011,469(2):613-616.
[10]朱敏,徐永清,丁晶,等.一种取滑丝螺钉的方法[J].中国骨与关节损伤杂志,2012,27(5):475.
[11]殷渠东,顾三军,孙振中,等.钢板上螺钉取出困难的处理策略[J].中国修复重建外科杂志,2015,29(2):141-144.