Scheider Philipp, Ganger Rudolf, Farr Sebastian
Military Hospital.
Orthopedic Hospital Speising, Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Vienna, Austria.
Medicine (Baltimore). 2020 Jan;99(5):e19010. doi: 10.1097/MD.0000000000019010.
Previous studies indicated that hardware removal may lead to increased morbidity and therefore, at least in adults, remains questionable for certain indications. However, risks such as corrosion or local reactions may be less likely in younger patients with current, improved hardware materials. We sought to retrospectively determine complication rates of hardware removal in pediatric upper limb surgery, and establish potential risk factors for increased morbidity.All children and adolescents who underwent inpatient hardware removal under anesthesia after previous upper limb surgery between 2002 and 2016 were retrospectively evaluated. The following details were extracted at the latest follow-up: demographics, implant location, hardware material, duration of surgery, duration of hardware in situ, and any complications graded according to Goslings et al (grade 0-5) and Sink et al (grade 1-5), respectively. Correlations were calculated to establish potential relationships between specific outcome parameters (e.g., location, duration of surgery etc.) and complication grades.A total of 2089 children were evaluated of whom 317 patients with 449 interventions (mean age 9.4 years) fulfilled the inclusion criteria for this study. Overall, 203 K-wires (46%), 97 plates (22%), 102 external fixators (23%), 32 intramedullary nails (7%), 6 screws (1%), 4 cerclages (1%) and 1 pin (0.2%) were removed; most common locations were the forearm (34%) and humerus (24%). The mean duration of surgery was 40 minutes (± 50.9), mean time in situ was 194 days (± 319.6). Complication rates were low overall, with most being grade 0 (n = 372; 83%) or 1 (n = 60; 13%) according to Goslings et al and grade 1 (n = 386; 86%) and 2 (n = 42; 9%) according to Sink et al. No severe complications were observed. The following predictors were related to the severity of the complications in linear regression analysis: more distal localizations, external fixators, longer duration of surgery and female sex.Hardware removal under anesthesia in the pediatric upper extremity has produced a low complication rate with no severe complications and can thus be considered to be safe. Increased morbidity occurred in more distal localizations, external fixators, longer surgeries and females.Level of Evidence: Therapeutic, Level IV.
以往研究表明，取出内固定装置可能会导致发病率增加，因此，至少在成人中，对于某些适应证而言，取出内固定装置仍存在疑问。然而，对于使用当前改良内固定材料的年轻患者，腐蚀或局部反应等风险可能较低。我们试图回顾性确定小儿上肢手术中取出内固定装置的并发症发生率，并确定发病率增加的潜在风险因素。
对2002年至2016年间，所有在先前上肢手术后接受麻醉下住院取出内固定装置的儿童和青少年进行回顾性评估。在最近一次随访时提取以下详细信息：人口统计学资料、植入物位置、内固定材料、手术时长、内固定装置在位时间，以及根据戈斯林等人（0 - 5级）和辛克等人（1 - 5级）分别分级的任何并发症。计算相关性以确定特定结果参数（如位置、手术时长等）与并发症分级之间的潜在关系。
总共评估了2089名儿童，其中317例患者共进行了449次手术干预（平均年龄9.4岁）符合本研究的纳入标准。总体而言，共取出203根克氏针（46%）、97块钢板（22%）、102个外固定架（23%）、32根髓内钉（7%）、6枚螺钉（1%）、4根环扎带（1%）和1枚钢针（0.2%）；最常见的位置是前臂（34%）和肱骨（24%）。平均手术时长为40分钟（±50.9），平均在位时间为194天（±319.6）。总体并发症发生率较低，根据戈斯林等人的分级，大多数为0级（n = 372；83%）或1级（n = 60；13%），根据辛克等人的分级，大多数为1级（n = 386；86%）和2级（n = 42；9%）。未观察到严重并发症。在线性回归分析中，以下预测因素与并发症的严重程度相关：更靠远端的位置、外固定架、更长的手术时长和女性性别。
小儿上肢麻醉下取出内固定装置的并发症发生率较低，未出现严重并发症，因此可认为是安全的。在更靠远端的位置、使用外固定架、手术时间较长以及女性患者中，发病率有所增加。
治疗性，四级。
