Ochs B G, Gonser C E, Baron H C, Stöckle U, Badke A, Stuby F M
Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls-Universität Tübingen, Schnarrenbergstraße 95, 76076, Tübingen, Deutschland.
Unfallchirurg. 2012 Apr;115(4):323-9. doi: 10.1007/s00113-012-2155-6.
Refractures of long bones after implant removal are a rare but serious complication, which in most cases make a reoperation necessary. We analysed our own cases and reviewed the scarce literature on this subject. As a result we found that it is possible to reduce this complication by performing thorough preoperative preparation, observing an adequate interim time between initial osteosynthesis and hardware removal, cautiously exposing the weakened bone to force for a certain time period after implant removal and taking the character of the fracture healing into consideration. It is not possible to entirely eradicate this complication because a lot of patients demand the implant removal even though it is known that demineralisation and residual screw holes both induce a reduction of energy-absorbing capacity and therefore predispose the patient to refracture. In some cases the surgeon should recommend that the implants remain in situ.
取出内固定物后长骨再骨折是一种罕见但严重的并发症，多数情况下需要再次手术。我们分析了自己的病例并查阅了关于该主题的少量文献。结果发现，通过进行全面的术前准备、注意初次骨固定与取出内固定物之间有足够的间隔时间、取出内固定物后在一定时间段内谨慎避免对弱化的骨骼施加外力以及考虑骨折愈合的特点，有可能减少这种并发症。由于很多患者即便知道去矿化和残留螺钉孔都会导致能量吸收能力下降从而使患者易发生再骨折，仍要求取出内固定物，所以不可能完全消除这种并发症。在某些情况下，外科医生应建议保留内固定物。
