Kasai Taro, Matsumoto Takumi, Iga Toru, Tanaka Sakae
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Orthopaedic Surgery, Tokyo Metropolitan Tama Medical Center, 2-28-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan.
J Orthop. 2019 Feb 28;16(3):191-194. doi: 10.1016/j.jor.2019.02.017. eCollection 2019 May-Jun.
Although the complications of internal fixation in ankle fractures are well-known in a number of reports, there have been few reports revealing the complications of implant removal in ankle fractures. The aim of this study was to investigate the perioperative complications of implant removal in ankle fractures and analyze the associated factors of such complications.
Patients who underwent open reduction and internal fixation using metal implants for ankle fractures and had their implants removed between 2010 and 2015 were enrolled in the study. We investigated the rate and details of perioperative complications and collected information on the possible risk factors including the age, comorbidities, fracture type, number of skin incisions, operative time, and surgeon's grade from the medical charts.
A total of 80 patients were included for analysis. Perioperative complications occurred in 11 patients (14%) including arterial injury in one patient, blistering in three, nerve injuries in three, skin necrosis in two, and infection in two. In patients with perioperative complications, the rate of patients with peripheral vascular disease and multiple skin incision was significantly higher (18% vs 3%, = 0.031 and 64% vs 32%, = 0.042, respectively) and the operative time was significantly longer (102 min vs 57 min, < 0.001) than those without perioperative complications.
The indication of implant removal in ankle fractures should be considered carefully, especially in patients with possible risk factors and without implant-related symptoms, due to the high incidence of perioperative complications.
尽管多项报告中已熟知踝关节骨折内固定的并发症，但鲜有报告揭示踝关节骨折内固定物取出的并发症。本研究旨在调查踝关节骨折内固定物取出的围手术期并发症，并分析此类并发症的相关因素。
纳入2010年至2015年间接受踝关节骨折切开复位内固定术并取出内固定物的患者。我们调查了围手术期并发症的发生率及详细情况，并从病历中收集了可能的风险因素信息，包括年龄、合并症、骨折类型、皮肤切口数量、手术时间和外科医生级别。
共80例患者纳入分析。11例患者（14%）发生围手术期并发症，包括1例动脉损伤、3例水泡形成、3例神经损伤、2例皮肤坏死和2例感染。发生围手术期并发症的患者中，外周血管疾病患者和多处皮肤切口患者的比例显著更高（分别为18%对3%，P = 0.031；64%对32%，P = 0.042），且手术时间显著更长（102分钟对57分钟，P < 0.001）。
由于围手术期并发症发生率较高，踝关节骨折内固定物取出的指征应仔细考虑，尤其是对于有潜在风险因素且无内固定物相关症状的患者。
