Acklin Yves P, Bircher Andreas, Morgenstern Mario, Richards R Geoff, Sommer Christoph
Universitätsspital Basel, Department of Orthopaedics and Traumatology, Basel, Switzerland.
University Hospital Basel, Department of Infectiology and Allergology, Basel, Switzerland.
Injury. 2018 Jun;49 Suppl 1:S91-S95. doi: 10.1016/S0020-1383(18)30311-5.
Routine implant removal is frequently performed although evidence-based guidelines are lacking. But routinely planned implant removal has significant economic implications and shows considerable complication rates. In general, clinical outcome seems to improve but pain relief after operation is often unpredictable. Even in patients reporting implant-related pain, implant removal does not guarantee relief and may be associated with further complications. The intra- and postoperative complication rate remains very high. Implant removal demonstrates a significant learning curve and unsupervised junior surgeons tend to cause more complications. The need for implant removal may be questioned. Even with the implant in place, contact activities can be resumed. However, a new adequate trauma can create a new fracture independently if there is an implant in-situ or not. It is important to understand the complications and outcomes to be expected with hardware removal to carefully evaluate its indication.
尽管缺乏循证指南，但常规取出植入物的操作仍经常进行。然而，常规计划取出植入物具有重大的经济影响，且并发症发生率相当高。总体而言，临床结果似乎有所改善，但术后疼痛缓解情况往往难以预测。即使是报告有植入物相关疼痛的患者，取出植入物也不能保证疼痛缓解，且可能会引发更多并发症。术中及术后并发症发生率仍然很高。取出植入物存在显著的学习曲线，且未经监督的低年资外科医生往往会导致更多并发症。取出植入物的必要性可能值得质疑。即使植入物仍在原位，也可以恢复接触性活动。然而，无论植入物是否在位，新的足够严重的创伤都可能独立引发新的骨折。了解取出内固定装置可能出现的并发症和预期结果对于仔细评估其适应证很重要。
