胫骨骨折愈合后取出内固定物。
Hardware removal after tibial fracture has healed.
作者信息
Sidky Adam, Buckley Richard E
机构信息
University of Calgary, Foothills Medical Centre, Calgary, Alta.
出版信息
Can J Surg. 2008 Aug;51(4):263-8.
BACKGROUND
Tibial fractures are the most common long bone fracture. The standard of care for the treatment of diaphyseal tibial fractures is an intramedullary nail (IMN). Implant removal is one of the most common procedures in bone and joint surgery, and criteria for implant removal are typically left to the treating surgeon. Currently, no clear criteria exist to guide a surgeon's decision to remove implanted tibial IMNs after healing.
METHODS
We undertook a retrospective chart review of a single surgeon's practice from January 1996 to February 2005. We identified patients aged 16-70 years with a tibial fracture treated with an IMN. Patients were followed until fracture union and/or request for IMN removal. The following parameters were recorded: reason for implant removal, age, sex, mechanism of fracture, location of fracture, diameter of IMN, Workers' Compensation Board (WCB) status, activity level, litigation status, insurance involvement, height, weight and body mass index (BMI).
RESULTS
Factors influencing the likelihood of removal were sex and litigation. Factors not influencing the likelihood of removal were age, weight, height, BMI, diameter of IMN, patients' level of activity, insurance claim involvement and WCB involvement. Overall, 72.2% of patients had an improvement in their symptoms after IMN removal.
CONCLUSION
Sex and litigation are positive predictive factors for patient requests to have tibial IMNs removed after healing.
背景
胫骨骨折是最常见的长骨骨折。治疗胫骨干骨折的标准治疗方法是髓内钉（IMN）。内植物取出是骨与关节外科最常见的手术之一，内植物取出的标准通常由主刀医生决定。目前，尚无明确标准指导外科医生在骨折愈合后决定取出植入的胫骨髓内钉。
方法
我们对一位外科医生在1996年1月至2005年2月期间的临床实践进行了回顾性病历审查。我们确定了年龄在16 - 70岁之间、接受髓内钉治疗的胫骨骨折患者。对患者进行随访直至骨折愈合和/或要求取出髓内钉。记录了以下参数：取出内植物的原因、年龄、性别、骨折机制、骨折部位、髓内钉直径、工人赔偿委员会（WCB）状态、活动水平、诉讼状态、保险参与情况、身高、体重和体重指数（BMI）。
结果
影响取出可能性的因素是性别和诉讼。不影响取出可能性的因素是年龄、体重、身高、BMI、髓内钉直径、患者活动水平、保险索赔参与情况和WCB参与情况。总体而言，72.2%的患者在取出髓内钉后症状有所改善。
结论
性别和诉讼是骨折愈合后患者要求取出胫骨髓内钉的阳性预测因素。
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