Hsu Lawrence P, Schwartz Edric G, Kalainov David M, Chen Franklin, Makowiec Richard L
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Hand Surg Am. 2011 Apr;36(4):610-6. doi: 10.1016/j.jhsa.2011.01.023.
Surgeons often use smooth K-wires for bone stabilization in the hand and wrist. The purposes of this study were to observe the incidence of postoperative complications of K-wire fixation in the hand and wrist and to identify associated risk factors.
A total of 189 patients underwent bone and soft tissue procedures in the hand and wrist with insertion of 408 smooth K-wires. All patients were instructed to comply with a uniform pin care protocol and were observed for a minimum of 1 examination after pin removal. Complications were categorized as minor or major, with 3 subcategories for infectious complications. We compared total complications and infectious complications with patient age, comorbidities, soft tissue integrity, pin exposure (external or buried), number of pins inserted, pin location, compliance with pin site care, and empiric antibiotic treatment.
We found that 39 patients experienced postoperative complications involving 58 K-wires (14% of all pins). Most complications were minor, commonly superficial pin track infection (24 pins, 6% of all pins). Major complications occurred less frequently (11 pins, 3% of all pins) and included complications that led to additional surgery (deep infection, malunion, or nonunion) and fractures through the pin track. The development of an infectious complication was associated with 2 factors: pin location in the hand versus the wrist and poor compliance with pin site care. Patient age, medical comorbidities, soft tissue integrity, pin exposure, number of pins inserted, and empiric antibiotic treatment had no statistically significant relationships to the occurrence of complications.
Complications with smooth K-wire fixation in the hand and wrist are relatively uncommon. Most complications involve minor, superficial pin track infections. Location of pins in the hand as compared with the wrist and poor patient compliance with pin site care may increase the risk of infection.
外科医生常使用光滑克氏针对手部和腕部骨骼进行固定。本研究的目的是观察手部和腕部克氏针固定术后并发症的发生率，并确定相关危险因素。
共有189例患者接受了手部和腕部的骨骼及软组织手术，并插入了408根光滑克氏针。所有患者均被要求遵守统一的针护理方案，并在拔针后至少观察1次检查。并发症分为轻微或严重，感染性并发症有3个亚类。我们将总并发症和感染性并发症与患者年龄、合并症、软组织完整性、针外露情况（外露或埋入）、插入针的数量、针的位置、针部位护理的依从性以及经验性抗生素治疗进行了比较。
我们发现39例患者出现了术后并发症，涉及58根克氏针（占所有针的14%）。大多数并发症为轻微并发症，常见的是浅表针道感染（24根针，占所有针的6%）。严重并发症发生率较低（11根针，占所有针的3%），包括导致再次手术的并发症（深部感染、畸形愈合或不愈合）以及针道骨折。感染性并发症的发生与2个因素有关：针在手部与腕部的位置以及针部位护理依从性差。患者年龄、内科合并症、软组织完整性、针外露情况、插入针的数量以及经验性抗生素治疗与并发症的发生无统计学显著关系。
手部和腕部光滑克氏针固定的并发症相对不常见。大多数并发症为轻微的浅表针道感染。与腕部相比，针在手部的位置以及患者对针部位护理的依从性差可能会增加感染风险。
