锁骨中段骨折采用预塑形的前路钢板固定后二次手术及植入物取出率较低。
Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures.
作者信息
Ryan Patrick M, Wilson Charlie, Volkmer Randy, Hisle Garret, Brennan Michael, Stahl Daniel
机构信息
Department of Orthopaedic Surgery, Baylor Scott and White Medical Center - Temple, Temple, Texas.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
出版信息
Proc (Bayl Univ Med Cent). 2023 May 12;36(4):461-467. doi: 10.1080/08998280.2023.2210790. eCollection 2023.
BACKGROUND
Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed. However, dual-plating systems have disadvantages, including increased cost and increased surgical morbidity. The aim of this study was to define the rate of symptomatic hardware removal for all midshaft clavicle fractures.
METHODS
We retrospectively reviewed information on all patients from 2014 to 2018 at a single level 1 trauma institution with surgeries performed by two fellowship-trained orthopedic trauma surgeons. Documented removal of hardware and the reason for removal were recorded. We then contacted all patients at their listed telephone number to confirm the hardware was still in place and to administer patient outcome questionnaires. If patients did not answer, attempts were made to contact them multiple times on multiple days. Those who were not reached but had documented hardware removal were included in the total number of patients with hardware removal.
RESULTS
The search revealed 158 patients, of whom 89 (61.8%) were included in the study. Average follow up was 4.09 years (range 2.02-6.50 years). Five patients (5.56%) underwent hardware removal. Removal was for symptomatic or irritating hardware in two of these patients (2.22%). Average abbreviated Disability of Arm, Shoulder, and Hand score was 6.27, and average American Society of Shoulder and Elbow Surgeons shoulder score was 93.6.
CONCLUSION
In our series, the rate of symptomatic hardware removal was 2.22%, well below reported removal rates. Hardware removal rates for prominent symptomatic superior clavicular plates may be significantly lower than previously reported, and these fractures may be adequately treated with a single, superior plate.
背景
采用单一3.5毫米锁骨上方钢板对锁骨中段骨折进行手术固定，因内固定装置出现症状而导致较高的内固定取出率。因此，有人提出使用外形更小巧的植入物的双钢板技术。然而，双钢板系统存在缺点，包括成本增加和手术并发症增多。本研究的目的是确定所有锁骨中段骨折患者出现症状性内固定取出的发生率。
方法
我们回顾性分析了2014年至2018年在一家一级创伤机构接受手术的所有患者的资料，手术由两位接受过专科培训的骨科创伤外科医生进行。记录内固定取出情况及取出原因。然后我们拨打所有患者登记的电话号码，确认内固定是否仍在位，并发放患者结局调查问卷。如果患者未接听，会在多日多次尝试联系他们。那些未联系到但有记录显示内固定已取出的患者被纳入内固定取出患者总数。
结果
检索发现158例患者，其中89例（61.8%）纳入研究。平均随访时间为4.09年（范围2.02 - 6.50年）。5例患者（5.56%）接受了内固定取出。其中2例患者（2.22%）因内固定装置出现症状或引起不适而取出。手臂、肩部和手部功能障碍简易评分平均为6.27，美国肩肘外科医师学会肩部评分平均为93.6。
结论
在我们的系列研究中，症状性内固定取出率为2.22%，远低于报道的取出率。突出的有症状的锁骨上方钢板的内固定取出率可能显著低于先前报道，这些骨折采用单一的上方钢板可能得到充分治疗。
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