骨折愈合后取出疼痛的骨科植入物。

Removal of painful orthopaedic implants after fracture union.

作者信息

Minkowitz Reuven B, Bhadsavle Siraj, Walsh Michael, Egol Kenneth A

机构信息

New York University-Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.

出版信息

J Bone Joint Surg Am. 2007 Sep;89(9):1906-12. doi: 10.2106/JBJS.F.01536.

DOI:10.2106/JBJS.F.01536

PMID:17768185

Abstract

BACKGROUND

Persistent pain in the region of implanted hardware following fracture fixation commonly leads to implant removal. This prospective study evaluated patient outcomes and pain reduction following removal of orthopaedic hardware implanted for fracture fixation.

METHODS

Sixty patients who had been treated previously for a fracture and complained of pain in the region of the fracture fixation hardware constituted the study cohort. Patients were carefully examined by the treating physician to rule out other causes of pain such as infection and nonunion. Baseline data were recorded preoperatively. Data obtained postoperatively at three, six, and twelve months included a visual analog pain scale score and results on the Short Musculoskeletal Function Assessment Questionnaire and the Medical Outcomes Study Short Form-36. At the one-year interval, a patient satisfaction questionnaire was completed and outcomes were analyzed.

RESULTS

There were no complications associated with implant removal surgery. Three patients did not have complete follow-up, leaving a total of fifty-seven patients with complete follow-up. At one year, all patients indicated that they were satisfied, that they would have the procedure done again, and that their overall function had improved. The scores for pain on the visual analog scale decreased from a mean (and standard deviation) of 5.5 +/- 2.5 before hardware removal to 1.3 +/- 1.8 after hardware removal, with an overall improvement at one year of 76% (p = 0.00001). At one year, thirty (53%) of the fifty-seven patients had complete resolution of pain. In addition, the results on the Short Musculoskeletal Function Assessment Questionnaire showed a 43% improvement from baseline (p = 0.0001), and the results on the physical component of the Short Form-36 showed a similar improvement of 40% (p = 0.0001).

CONCLUSIONS

Following fracture-healing, removal of hardware is safe with minimal risk. Improvement in pain relief and function can be expected.

摘要

背景

骨折固定后植入物部位的持续性疼痛通常会导致植入物取出。这项前瞻性研究评估了因骨折固定而植入的骨科植入物取出后的患者预后及疼痛减轻情况。

方法

60例曾因骨折接受治疗且主诉骨折固定植入物部位疼痛的患者构成研究队列。主治医生对患者进行仔细检查，以排除疼痛的其他原因，如感染和骨不连。术前记录基线数据。术后3个月、6个月和12个月获得的数据包括视觉模拟疼痛量表评分以及短肌肉骨骼功能评估问卷和医学结局研究简表36的结果。在1年的时间间隔时，完成患者满意度问卷并分析结果。

结果

植入物取出手术无并发症。3例患者未完成随访，共有57例患者完成随访。1年时，所有患者均表示满意，愿意再次接受该手术，且整体功能有所改善。视觉模拟量表的疼痛评分从植入物取出前的平均（及标准差）5.5±2.5降至取出后的1.3±1.8，1年时总体改善率为76%（p = 0.00001）。1年时，57例患者中有30例（53%）疼痛完全缓解。此外，短肌肉骨骼功能评估问卷的结果显示较基线改善了43%（p = 0.0001），简表36身体部分的结果显示有类似的40%的改善（p = 0.0001）。