针道感染是外固定过程中与钢针松动相关的一个重要因素：对47例连续患者的前瞻性分析。

Pin-tract infection is an important factor associated with pin loosening during external fixation: a prospective analysis of 47 consecutive patients.

作者信息

Huang Yong-Yi, Huang Mou-Zhang, Zhang Ping, Song Chen-Sheng, Yao Yu, Yang Yu-Sheng, Tian Liang-Jie, Lin Qing-Rong, Han Ru-Hao, Xi Hong-Wei, Wang Bo-Wei, Jiang Nan, Hu Yan-Jun

机构信息

Division of Orthopaedics & Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou, China.

出版信息

Front Cell Infect Microbiol. 2025 Mar 27;15:1459205. doi: 10.3389/fcimb.2025.1459205. eCollection 2025.

DOI:10.3389/fcimb.2025.1459205

PMID:40212847

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11983403/

Abstract

BACKGROUND

The occurrence of pin loosening represents a common issue in the context of external fixation methodologies; nevertheless, a comprehensive investigation into the multifaceted causes of pin loosening, incorporating a multivariate analysis among pin infection, bone quality, and pin insertion angle, is notably absent in current literature. The present study endeavors to pinpoint factors associated with pin loosening through such a multivariate analysis.

METHODOLOGY

The study encompassed patients who underwent the removal of external fixators from March 2023 to July 2023. The assessment of pin loosening was executed through the utilization of the pin track score, the pin removal torque value (PRTV), and the radiolucent zone around the pin (RZAP) as depicted in digital radiography (DR) images. Culturing of the pin-bone interfaces was performed, and measurements of the grayscale intensity of cortical bone (GSCB) and pin verticality within DR images were taken. Multivariate analyses were conducted employing a Generalized Linear Mixed-Effects Model (GLMM), Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated by exponentiating the model coefficients (Exp(β)).

RESULTS

Altogether 47 patients with a total of 220 pins were included for analysis. The mean PRTV was 1.9 ± 2.1 N·m. The correlation analysis between PRTV and RZAP yielded a -value of less than 0.001, signifying a substantial correlation between pin loosening and RZAP. For pins with a PRTV of 0, the RZAP measured 1.9 ± 0.8 mm. The positive rate of bacterial culture was 20%, and the loosening rate was 26.8%. Pin loosening was significantly associated with bacterial infection (aOR = 2.24, 95% CI: 1.03-4.90, = 0.04) and GSCB (aOR = 0.50, 95% CI: 0.38-0.66, < 0.01), but not with pin verticality (aOR = 1.00, 95% CI: 0.93-1.08, = 0.99). Non-HA-coated pins remained significantly associated with bacterial infection (aOR = 8.20, 95% CI: 2.18-30.85, = 0.002), whereas HA-coated pins were not (aOR = 3.44, 95% CI: 0.24-48.76, = 0.36).

CONCLUSIONS

Pin loosening was significantly associated with bacterial infection at the pin-bone interface and lower GSCB, but not with pin verticality. Notably, infection strongly predicted loosening in non-HA-coated pins, while HA-coated pins demonstrated higher raw infection rates.

摘要

背景

在外部固定方法中，钢针松动是一个常见问题；然而，目前文献中明显缺乏对钢针松动多方面原因的全面研究，未纳入对钢针感染、骨质及钢针插入角度的多变量分析。本研究旨在通过这种多变量分析确定与钢针松动相关的因素。

方法

该研究纳入了2023年3月至2023年7月接受外固定器拆除的患者。通过使用钢针通道评分、钢针拔除扭矩值（PRTV）以及数字X线摄影（DR）图像中钢针周围的透亮区（RZAP）来评估钢针松动情况。对钢针-骨界面进行培养，并测量DR图像中皮质骨的灰度强度（GSCB）和钢针垂直度。采用广义线性混合效应模型（GLMM）进行多变量分析，通过对模型系数取指数（Exp(β)）计算调整后的比值比（aORs）及95%置信区间（CIs）。

结果

共纳入47例患者，总计220根钢针进行分析。平均PRTV为1.9±2.1N·m。PRTV与RZAP之间的相关性分析p值小于0.001，表明钢针松动与RZAP之间存在显著相关性。对于PRTV为0的钢针，RZAP为1.9±0.8mm。细菌培养阳性率为20%，松动率为26.8%。钢针松动与细菌感染（aOR = 2.24，95%CI：1.03 - 4.90，p = 0.04）和GSCB（aOR = 0.50，95%CI：0.38 - 0.66，p < 0.01）显著相关，但与钢针垂直度无关（aOR = 1.00，95%CI：0.93 - 1.08，p = 0.99）。未涂覆羟基磷灰石（HA）的钢针与细菌感染仍显著相关（aOR = 8.20，95%CI：2.18 - 30.85，p = 0.002），而涂覆HA的钢针则不然（aOR = 3.44，95%CI：0.24 - 48.76，p = 0.36）。