Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China.
J Cardiothorac Surg. 2023 Jul 4;18(1):214. doi: 10.1186/s13019-023-02330-1.
Internal fixation for rib fractures has been widely carried out worldwide, and its surgical efficacy has been recognized. However, there is still controversy about whether implant materials need to be removed. At present, the research on this topic is still lacking at home and abroad. Therefore, in this study, the patients undergoing removal of internal fixation for rib fractures in our department within one year were followed up, to statistically analyze implant-related complications, postoperative complications and postoperative remission rate.
A retrospective analysis was conducted on 143 patients undergoing removal of internal fixation for rib fractures from 2020 to 2021 in our center. The implant-related complications, postoperative complications and postoperative remission rate of patients with internal fixation were analyzed.
In this study, a total of 143 patients underwent removal of internal fixation, among which 73 suffered from preoperative implant-related complications (foreign-body sensation, pain, wound numbness, sense of tightness, screw slippage, chest tightness, implant rejection), and 70 had no post operative discomfort but asked for removal of internal fixation. The average interval between rib fixation and removal was 17 ± 9.00 (months), and the average number of removed materials was 5.29 ± 2.42. Postoperative complications included wound infection (n = 1) and pulmonary embolism (n = 1). of the 73 patients with preoperative implant-related complications, the mean postoperative remission rate was 82%. Among the 70 patients without preoperative discomfort, the proportion of discomforts after removal was 10%. No perioperative death occurred.
For patients with internal fixation for rib fractures, removal of internal fixation can be considered in the case of implant-related complications after surgery. The corresponding symptoms can be relieved after removal. The removal presents low complication rate, and high safety and reliability. For patients without obvious symptoms, it is safe to retain the internal fixation in the body. For the asymptomatic patients who ask for removal of internal fixation, the possible risk of complications should be fully informed before removal.
肋骨骨折内固定在全球范围内已广泛开展，其手术疗效得到认可。但对于内固定材料是否需要取出仍存在争议。目前国内外对此类课题的研究仍较少。因此，本研究对本科室一年内行肋骨骨折内固定取出术的患者进行随访，统计分析内固定相关并发症、术后并发症及术后缓解率。
回顾性分析 2020 年至 2021 年我中心 143 例行肋骨骨折内固定取出术患者的临床资料，分析患者内固定相关并发症、术后并发症及术后缓解率。
本研究共纳入 143 例行肋骨骨折内固定取出术患者，其中 73 例术前存在内固定相关并发症（异物感、疼痛、伤口麻木、紧束感、螺钉松动、胸闷、排异反应），70 例无术后不适但要求取出内固定。肋骨固定至取出的平均时间为 17±9.00（月），取出材料的平均数量为 5.29±2.42。术后并发症包括伤口感染 1 例，肺栓塞 1 例。73 例术前存在内固定相关并发症患者中，术后平均缓解率为 82%。70 例无术前不适患者中，术后出现不适的比例为 10%。无围手术期死亡。
对于肋骨骨折内固定患者，在术后出现内固定相关并发症时可考虑取出内固定，取出后相应症状可缓解。取出术并发症发生率低，安全性及可靠性高。对于无明显症状的患者，内固定物可安全留置于体内。对于无症状要求取出内固定的患者，应充分告知其可能出现的并发症风险。
