Wójtowicz Błażej G, Chawrylak Katarzyna, Lesman Jędrzej, Domżalski Marcin
Department of Orthopedics and Traumatology of the Musculoskeletal System, WAM University Clinical Hospital, Central Veterans Hospital, Żeromskiego 113 St., 90-549 Lodz, Poland.
Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland.
J Clin Med. 2024 Aug 15;13(16):4805. doi: 10.3390/jcm13164805.
: The aim of this systematic review is to examine the recent evidence comparing the removal and non-removal of syndesmotic screws in tibiofibular syndesmosis injuries in terms of functional, clinical, and radiographic outcomes. : A comprehensive literature review was conducted to identify clinical studies on syndesmotic screw removal and its outcomes, searching the Cochrane Library and PubMed Medline for publications from 1 January 2004 to 12 February 2024. Studies were included if they involved tibiofibular syndesmotic screw fixation, assessed screw removal or retention, described clinical outcomes, and were original research with at least fifteen patients per group. : Most reviewed articles (18 out of 27; 67%) found no significant differences between the routine removal and retention of syndesmotic screws post-fixation. Four retrospective studies (15%) suggested that retaining screws might result in worse outcomes compared to removal. Two studies (7%) indicated that removing screws could introduce additional risks. One study (4%) observed that post-removal, there is some fibula-tibia separation without affecting the medial clear space. Another study (4%) noted that intraosseous screw breakage might increase the need for implant removal due to pain. Additionally, no significant differences in ankle function were found among groups with varying intervals of screw removal. : The current literature does not definitively support routine removal of syndesmotic screws. Given the potential complications and financial costs, routine removal should not be performed unless specifically indicated.
本系统评价的目的是研究近期有关胫腓下联合损伤中固定后联合螺钉取出与不取出在功能、临床和影像学结果方面比较的证据。
进行了全面的文献综述，以确定关于联合螺钉取出及其结果的临床研究，在Cochrane图书馆和PubMed Medline中检索2004年1月1日至2024年2月12日期间的出版物。纳入的研究需涉及胫腓下联合螺钉固定、评估螺钉取出或保留情况、描述临床结果，且为每组至少有15例患者的原始研究。
大多数综述文章（27篇中的18篇；67%）发现固定后联合螺钉的常规取出与保留之间无显著差异。四项回顾性研究（15%）表明，与取出螺钉相比，保留螺钉可能导致更差的结果。两项研究（7%）指出，取出螺钉可能会带来额外风险。一项研究（4%）观察到，取出螺钉后，存在一定程度的腓骨 - 胫骨分离，但不影响内侧间隙。另一项研究（4%）指出，由于疼痛，骨内螺钉断裂可能会增加植入物取出的必要性。此外，在不同螺钉取出间隔的组中，踝关节功能未发现显著差异。
当前文献并未明确支持常规取出联合螺钉。鉴于潜在的并发症和经济成本，除非有明确指征，否则不应进行常规取出。
