Termer Andreas, Völler Thomas, Herlyn Anica, Fülling Tim, Gierer Philip
Krankenhaus Dresden-Friedrichstadt, Dresden, Germany.
Universitätsmedizin Rostock, Rostock, Germany.
Arch Orthop Trauma Surg. 2025 Jun 4;145(1):334. doi: 10.1007/s00402-025-05949-y.
While there are clear indications for osteosynthesis for different types of fracture, only few indications exist for routine implant removals (IR). Therefore, we suggest there is no significant difference in pain development or subjective improvement of function after an IR regardless of the indication.
This prospective single-center study includes all patients undergoing IR from 07/2014 to 06/2017. Questionnaires were filled out before IR as well as 3 and 12 months after surgery. There was an additional questionnaire for the surgeon before and after the surgery. Collected data included demographics as well as information about comorbidities, smoking status, surgeon's experience level, indication, complications, localization and type of implant, expectation, and perception of pain development as well as subjective change of function.
A total of 237 patients with 322 implants were included in the study, of which 41% (n = 97) were female and 59% (n = 140) male. The average age was 45.4 ± 15.5 years at the time of IR. All categories showed significant improvement 3 and 12 months after IR. There was significant difference between different types of indication, localization, complication, and retention of implant. The willingness to repeat IR was high. Pedicle screws and tension band wiring stand out with low intraoperative complication rates. Some localizations, such as the upper arm, patella, and spine, tend to have lower intraoperative complication rates, while others, such as the thigh, pelvis, and forearm, are prone to higher intraoperative complication rates. Further factors, such as body-mass-index (BMI), smoking status, diabetes mellitus, and osteoporosis, showed no significant difference in intraoperative complication rates. Neither did different levels of surgeon's experience. Surgeon's expectation for functional improvement had a negative correlation with the patient's perception of functional improvement 3 months after IR.
Different complication rates were detected for different localizations and types of implant. Regardless of the indication most patients had a great benefit from an IR and would repeat it, given the choice. Perceived overall improvement does not correlate with the surgeon's expectation. Therefore, this study insists on an informed decision-making concept, which does not underestimate the patient's wish for an IR as a valid indication.
虽然不同类型骨折的骨合成有明确指征，但常规植入物取出术（IR）的指征却很少。因此，我们认为无论指征如何，IR术后疼痛发展或功能主观改善方面均无显著差异。
这项前瞻性单中心研究纳入了2014年7月至2017年6月期间所有接受IR的患者。在IR术前以及术后3个月和12个月填写问卷。此外，为外科医生在手术前后各准备了一份问卷。收集的数据包括人口统计学信息以及合并症、吸烟状况、外科医生经验水平、指征、并发症、植入物的位置和类型、期望、疼痛发展感知以及功能主观变化等信息。
本研究共纳入237例患者的322枚植入物，其中41%（n = 97）为女性，59%（n = 140）为男性。IR时的平均年龄为45.4±15.5岁。所有类别在IR术后3个月和12个月均有显著改善。不同类型的指征、位置、并发症和植入物留存情况之间存在显著差异。重复IR的意愿较高。椎弓根螺钉和张力带钢丝的术中并发症发生率较低。一些部位，如上臂、髌骨和脊柱，术中并发症发生率往往较低，而其他部位，如大腿、骨盆和前臂，术中并发症发生率则较高。其他因素，如体重指数（BMI）、吸烟状况、糖尿病和骨质疏松症，在术中并发症发生率方面无显著差异。外科医生的不同经验水平也无差异。外科医生对功能改善的期望与患者在IR术后3个月对功能改善的感知呈负相关。
不同位置和类型的植入物检测到不同的并发症发生率。无论指征如何，大多数患者从IR中获益巨大，若有选择，他们会再次接受。总体感知改善与外科医生的期望无关。因此，本研究坚持知情决策理念，即不应低估患者对IR作为有效指征的意愿。
