Quade Jonathan, Busel Gennadiy, Beebe Michael, Auston Darryl, Shah Anjan R, Infante Anthony, Maxson Benjamin, Watson David, Sanders Roy W, Mir Hassan R
Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL.
J Orthop Trauma. 2019 Jul;33(7):351-353. doi: 10.1097/BOT.0000000000001453.
To calculate the incidence of symptomatic iliosacral (SI) screw removal following pelvic trauma and to determine the clinical impact of the secondary intervention.
Retrospective chart review.
Level 1 and Level 2 trauma centers.
Four hundred seventy-one consecutive patients undergoing percutaneous posterior pelvic fixation over 10 years, with 7 excluded for spinopelvic fixation,and 7 excluded due to age <16 year old.
Implant removal.
Secondary intervention.
A total of 25/457 patients underwent screw removal (5.4%). Two patients were lost to follow-up, leaving 23 for analysis. There were 13 male patients and 10 female patients. There were 13 SI and 10 trans-sacral screws removed. Four screws were loose before removal (17%). Average time to screw removal was 10.7 months (4-26 minutes). Fifteen (83.3%) patients had subjective improvement, and 3 (16.7%) had no notable improvement.
The incidence of symptomatic SI screws necessitating removal is low (5.4%). When removed, there is a high likelihood (83%) that the secondary intervention will result in subjective symptomatic improvement. Routine screw removal is unnecessary because most patients tolerate the implants without symptoms necessitating subsequent surgery.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
计算骨盆创伤后有症状的髂骶(SI)螺钉取出率,并确定二次干预的临床影响。
回顾性图表审查。
一级和二级创伤中心。
连续471例患者在10年内接受经皮后路骨盆固定,其中7例因脊柱骨盆固定被排除,7例因年龄<16岁被排除。
取出内固定物。
二次干预。
共有25/457例患者取出螺钉(5.4%)。2例患者失访,剩余23例进行分析。男性患者13例,女性患者10例。共取出13枚SI螺钉和10枚经骶骨螺钉。取出前有4枚螺钉松动(17%)。螺钉取出的平均时间为10.7个月(4 - 26分钟)。15例(83.3%)患者主观症状改善,3例(16.7%)无明显改善。
有症状需要取出的SI螺钉发生率较低(5.4%)。取出螺钉后,二次干预很有可能(83%)使主观症状得到改善。常规取出螺钉没有必要,因为大多数患者能够耐受内固定物,不会出现需要后续手术的症状。
治疗性四级证据。有关证据水平的完整描述,请参阅《作者须知》。