James K, Uppada Uday Kiran, Bharadwaj B, Swayampakula Himaja
Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India.
Department of Dentistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
Natl J Maxillofac Surg. 2024 Jan-Apr;15(1):75-81. doi: 10.4103/njms.njms_11_23. Epub 2024 Mar 19.
To evaluate the surface, compositional, and histological changes in the overlying soft tissues of retrieved stainless-steel mini-plates and screws used for rigid internal fixation in the maxillofacial skeleton.
A prospective study was conducted comprising 60 patients who sustained maxillofacial trauma and underwent ORIF in our unit previously and who required hardware retrieval in the post-operative phase. The retrieved hardware was evaluated for surface and compositional changes with the help of a scanning electron microscope for surface roughness and corrosion changes. Energy-dispersive X-ray study was done to know the composition and metal release from the hardware. The data obtained from these results were compared with a control unused and a sterile stainless-steel mini-plate and screw. The effects of the corrosion changes of this hardware on the adjacent soft tissues were evaluated histologically to assess the cellular changes of the soft tissue cover overlying the stainless-steel mini-plates and screws.
A total of 96 stainless-steel mini-plates and 380 stainless-steel screws were retrieved from 60 patients. The control plate was smooth without any surface and corrosion defects, while the retrieved mini-plates irrespective of the reason for removal have shown surface roughness. Fe and Ni ions were found to be significantly reduced in the retrieved mini-plates. The presence of CrC in the retrieved plates indicates corrosion, which was seen only in hardware retrieved from symptomatic patients. The histological study revealed chronic inflammatory cell infiltrate with hyalinized connective tissue in all the samples irrespective of the reason for the removal of the plate.
Stainless-steel mini-plates and screws act as a potent foreign body material and initiate a localized inflammatory reaction due to its corrosive products with longer duration of stay. Hence, the authors advocate the overall shift in the use of stainless-steel hardware to titanium hardware for ORIF.
评估用于颌面骨骼坚固内固定的取出不锈钢微型钢板和螺钉覆盖的软组织的表面、成分和组织学变化。
进行了一项前瞻性研究，纳入60例曾在本单位接受颌面创伤并接受切开复位内固定术且术后需要取出内固定物的患者。借助扫描电子显微镜评估取出的内固定物的表面粗糙度和腐蚀变化，以了解其表面和成分变化。进行能量色散X射线研究以了解内固定物的成分和金属释放情况。将这些结果获得的数据与未使用的对照无菌不锈钢微型钢板和螺钉进行比较。通过组织学评估该内固定物的腐蚀变化对相邻软组织的影响，以评估覆盖不锈钢微型钢板和螺钉的软组织覆盖层的细胞变化。
从60例患者中总共取出96块不锈钢微型钢板和380枚不锈钢螺钉。对照钢板表面光滑，无任何表面和腐蚀缺陷，而取出的微型钢板无论取出原因如何均显示表面粗糙度。发现取出的微型钢板中Fe和Ni离子显著减少。取出的钢板中存在CrC表明存在腐蚀，这仅在有症状患者取出的内固定物中可见。组织学研究显示，所有样本中均有慢性炎性细胞浸润和玻璃样变的结缔组织，无论钢板取出原因如何。
不锈钢微型钢板和螺钉作为一种有效的异物材料，由于其腐蚀性产物在体内停留时间较长，会引发局部炎症反应。因此，作者提倡在切开复位内固定术中将不锈钢内固定物全面更换为钛内固定物。
