Gu Kai, Qin Jiaqiang, Guo Meizhen, Chu Ruiliang, Chen Jiaxu, Qian Fusheng, Zhong Yi
Department of Orthopedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
Big Data Engineering Center (Medical Records Management Center), Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Pediatr. 2025 Apr 15;13:1535675. doi: 10.3389/fped.2025.1535675. eCollection 2025.
Cannulated screws are widely used in pediatric orthopedic fixation. However, traditional screw removal requires preoperative x-ray positioning, leading to exposure to ionizing radiation. Sometimes, a larger incision is required, and trauma is a significant cause of x-ray positioning, which cannot be accurately marked on the skin. In this study, we aimed to evaluate the practicability of rapid removal of cannulated screws through a guide needle and small incision using ultrasound (US) guidance to locate the position of the screws accurately.
A retrospective analysis was performed on patients who underwent removal of internal fixation after proximal tibial fracture surgery at our hospital between January 2019 and March 2024. Patients were divided into Group A and Group B based on the different cannulated screw removal techniques. In Group A, the cannulated screws were removed under US guidance, while in Group B, they were removed under direct visualization using a traditional incision. The operative time, blood loss, success rate of removal, radiation frequency, and incision length were statistically analyzed. Knee function was evaluated using the Knee Society Score.
53 patients aged 15.3 ± 0.1 years were included in this study. Group A showed 50% shorter incision length (1.5 vs. 3.0 cm, = 0.005) and average screw incisions (0.5 vs. 1.0 cm, = 0.007), along with complete elimination of preoperative radiation exposure (0 vs. 2 times, < 0.001) and dose (0 vs. 0.102 mGy, < 0.001) compared to Group B. Participants in Group A had no postoperative complications, whereas one patient in Group B had an incision infection; however, no significant difference was observed between the groups.
US-guided cannulated screw removal can be used in children with proximal tibial fractures, significantly reducing the preoperative radiation time and dose while minimizing the incisional length.
III.
空心螺钉广泛应用于小儿骨科固定。然而，传统的螺钉取出需要术前X线定位，这会导致暴露于电离辐射。有时，需要更大的切口，而且创伤是X线定位的一个重要原因，无法在皮肤上准确标记。在本研究中，我们旨在评估通过导针和小切口，利用超声（US）引导准确定位螺钉位置，快速取出空心螺钉的实用性。
对2019年1月至2024年3月在我院接受胫骨近端骨折手术后内固定取出的患者进行回顾性分析。根据空心螺钉取出技术的不同，将患者分为A组和B组。A组在超声引导下取出空心螺钉，而B组采用传统切口直接直视下取出。对手术时间、出血量、取出成功率、辐射次数和切口长度进行统计学分析。使用膝关节协会评分评估膝关节功能。
本研究纳入了53例年龄为15.3±0.1岁的患者。与B组相比，A组的切口长度缩短了50%（1.5对3.0 cm，P = 0.005），平均螺钉切口也缩短了（0.5对1.0 cm，P = 0.007），同时完全消除了术前辐射暴露（0对2次，P < 0.001）和剂量（0对0.102 mGy，P < 0.001）。A组患者术后无并发症，而B组有1例患者发生切口感染；然而，两组之间未观察到显著差异。
超声引导下取出空心螺钉可用于胫骨近端骨折的儿童，显著减少术前辐射时间和剂量，同时使切口长度最小化。
III级。
