Auckland City Hospital, Grafton, Auckland, New Zealand.
Bathurst and Orange Orthopaedic Surgeons Association, Orange, NSW, Australia.
J Orthop Surg (Hong Kong). 2020 Sep-Dec;28(3):2309499020944086. doi: 10.1177/2309499020944086.
There has been a global trend towards individually packaged screws for orthopaedic operations. Traditional practice makes use of screw caddies that require re-sterilization. Individually wrapped screws (IWS) are purported to decrease infection rates and avoid the deleterious effects of repeated screw sterilizations, despite marginal evidence. This review aimed to evaluate the safety, effectiveness and economics of screw caddies with IWS.
The literature was surveyed in a systematic fashion between 1998 and 2017 and all relevant health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, case-controlled studies and case series were sought. Any benefits or otherwise of IWS over screw caddies were then evaluated in the areas of safety, effectiveness and economics.
Two level III-3 papers suggested the use of caddies at least as safe as individual screws. Four level III-2 papers demonstrated that screws from caddies were as effective as individual alternatives, while a level III-3 paper reported that individual screws were significantly more expensive than screw caddies. Cost increases to our regional health service from ankle open reduction and internal fixations alone of at least $50,112 (AUD) per annum were calculated.
From the results obtained, the authors recommend the continued use of screw caddies for orthopaedic procedures.
在骨科手术中，使用单独包装的螺钉已成为一种全球趋势。传统做法是使用需要重新消毒的螺钉盒。虽然证据有限，但单独包装的螺钉（IWS）据称可以降低感染率并避免重复螺钉消毒的有害影响。本综述旨在评估使用带 IWS 的螺钉盒的安全性、有效性和经济性。
系统地检索了 1998 年至 2017 年的文献，并寻找了所有相关的卫生技术评估、系统评价、荟萃分析、随机对照试验、队列研究、病例对照研究和病例系列研究。然后在安全性、有效性和经济性方面评估了 IWS 相对于螺钉盒的任何优势。
两篇三级-3 级文献表明，使用盒式包装至少与单独包装的螺钉一样安全。四篇三级-2 级文献表明，从盒式包装中取出的螺钉与单独的替代品一样有效，而一篇三级-3 级文献报告称，单独的螺钉比螺钉盒式包装贵得多。仅踝关节切开复位内固定术一项，每年对我们地区卫生服务机构的成本增加至少为 50,112 澳元（AUD）。
根据获得的结果，作者建议继续在骨科手术中使用螺钉盒。
