Department of Surgery and Traumatology, Reinier de Graaf Groep, Delft, The Netherlands.
Foot Ankle Int. 2011 Nov;32(11):1040-4. doi: 10.3113/FAI.2011.1040.
Currently, the metallic syndesmotic screw is the gold standard in the treatment of syndesmotic disruption. Whether or not this screw needs to be removed remains debatable. The aim of the current study was to determine the complications which occur following routine removal of the syndesmotic screw following operative treatment of unstable ankle fractures.
This was a retrospective study with consecutive cases in a Level-2 Trauma center. All patients with routine removal of a syndesmotic screw, following the treatment of an unstable ankle fracture, between January 1, 2004 and November 30, 2010 were included. Complications recorded were: 1) minor or major wound infection following removal of the syndesmotic screw, 2) recurrent syndesmotic diastasis, and 3) unnecessary removal of a broken screw, not recognized during preoperative planning prior to surgery.
A total of 76 patients were included. A wound infection occurred in 9.2% (N = 7) of which 2.6% (N = 2) were deep infections requiring reoperation. Recurrent syndesmotic diastasis was found in 6.6% (N = 5) of patients, and in 6.6% (N = 5) screws were broken at the time of implant removal. In the group with recurrent diastasis the screws were removed significantly earlier compared with the group without recurrent diastasis (Mann-Whitney U-test; p = 0.011) and the group with screw breakage had their screws significantly longer in place compared with the group without breakage (p = 0.038).
A total of 22.4% complications occurred upon routine removal of the syndesmotic screw. Removal might therefore be considered only in selected cases with complaints, after a minimum of eight to twelve weeks and using antibiotic prophylaxis during removal.
目前，金属下胫腓联合螺钉是治疗下胫腓联合分离的金标准。是否需要取出螺钉仍存在争议。本研究旨在确定在不稳定踝关节骨折的手术治疗后，常规取出下胫腓联合螺钉时发生的并发症。
这是一项在二级创伤中心进行的回顾性连续病例研究。所有在 2004 年 1 月 1 日至 2010 年 11 月 30 日期间因不稳定踝关节骨折接受治疗后常规取出下胫腓联合螺钉的患者均被纳入本研究。记录的并发症包括：1）下胫腓联合螺钉取出后出现轻微或严重的伤口感染，2）下胫腓联合再分离，以及 3）在术前计划中未发现的、不必要的螺钉断裂。
共纳入 76 例患者。9.2%（N=7）的患者发生伤口感染，其中 2.6%（N=2）为需要再次手术的深部感染。6.6%（N=5）的患者出现下胫腓联合再分离，6.6%（N=5）的患者在取出内固定物时螺钉断裂。在再分离组中，螺钉的取出时间明显早于无再分离组（Mann-Whitney U 检验；p=0.011），且螺钉断裂组的螺钉固定时间明显长于无断裂组（p=0.038）。
在常规取出下胫腓联合螺钉时，共发生 22.4%的并发症。因此，只有在有症状的患者中，在至少 8 至 12 周后，且在取出过程中使用抗生素预防的情况下，才可以考虑取出螺钉。
