Inan Muharrem, Sarikaya Ilker A, Seker Ali, Guven Mehmet F
*Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University †Cocuk Ortopedi Klinigi ‡Department of Orthopaedics and Traumatology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey.
J Pediatr Orthop. 2016 Jun;36(4):387-91. doi: 10.1097/BPO.0000000000000455.
Pediatric proximal femoral locking plates (PFLPs) are widely used when performing proximal femoral osteotomy in children with cerebral palsy (CP). The purpose of this study is to report the difficulties and risk factors of titanium PFLPs removal in CP.
PFLP removal was performed in 58 hips of 33 patients (17 males, 16 females). The mean age at the time of surgery (plate removal) was 10.9 (range, 5.7 to 19.2) years. The patients were divided into 2 groups as group 1 and 2, if any difficulty was observed during surgery or not.
Difficulty was not detected in 42 (72.4%) hips (group 1). Difficulties were encountered in 16 (27.6%) hips (group 2). A total of 364 screws were used (259 in group 1, 105 in group 2). The mean plate screw density ratios were 0.88 in group 1 and 0.94 in group 2. The difference between group 1 and 2 was statistically significant. The mean duration between the insertion and removal of the PFLP was 14.9 months (11.9 mo in group 1, 22.7 mo in group 2). The difference between group 1 and 2 was statistically significant. The screw heads were cut and the shafts were left in the bone in 4 hips (4 screws); 3 of these 4 screws were calcar screws. Therefore, calcar screw application can be accepted as a handicap for screw removal.
As a conclusion, this study suggested that difficulty in titanium PFLP removal in CP is common and PFLP removal is not a harmless procedure. A longer time from internal fixation to removal, increased plate screw density ratio, and calcar screw application are risk factors for difficulties in titanium PFLP removal in CP.
Level III.
小儿股骨近端锁定钢板（PFLP）在对脑瘫（CP）患儿进行股骨近端截骨术时被广泛应用。本研究的目的是报告脑瘫患儿钛制PFLP取出的困难及危险因素。
对33例患者（17例男性，16例女性）的58髋进行了PFLP取出术。手术（钢板取出）时的平均年龄为10.9岁（范围5.7至19.2岁）。根据手术中是否观察到困难，将患者分为1组和2组。
42髋（72.4%）未发现困难（1组）。16髋（27.6%）遇到困难（2组）。共使用了364枚螺钉（1组259枚，2组105枚）。1组的平均钢板螺钉密度比为0.88，2组为0.94。1组和2组之间的差异具有统计学意义。PFLP置入与取出之间的平均时间为14.9个月（1组11.9个月，2组22.7个月）。1组和2组之间的差异具有统计学意义。4髋（4枚螺钉）的螺钉头被切断，螺钉杆留在骨内；这4枚螺钉中有3枚是股骨距螺钉。因此，应用股骨距螺钉可被视为取出螺钉的一个障碍。
总之，本研究表明，脑瘫患儿钛制PFLP取出困难很常见，且PFLP取出并非无害操作。从内固定到取出的时间延长、钢板螺钉密度比增加以及应用股骨距螺钉是脑瘫患儿钛制PFLP取出困难的危险因素。
三级。
