可吸收螺钉固定的并发症及预防  

Absorbable screw internal fixation: Complications and prevention measures

作　　者：徐可林 殷渠东 顾三军 孙振中 寿奎水 

机构地区：[1]无锡市第九人民医院骨科,江苏省无锡市214000

出　　处：《中国组织工程研究》2013年第9期1605-1610,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在一些四肢特殊部位,可吸收螺钉已取代金属螺钉,取得了良好的固定效果,但是,也出现了一些并发症。有关可吸收螺钉固定的并发症原因和预防措施的文献较少。目的:分析可吸收螺钉固定并发症的发生率、原因和预防措施。方法:回顾性分析113例患者使用236枚可吸收螺钉或螺棒固定治疗临床资料,其中,四肢骨折92例,韧带重建21例,前者除4例胫骨干骨折外,其余均是近关节松质骨骨折。结果与结论:所有患者均随访12-48个月,平均20个月,并发症的总体发生率为10.6%。固定失败5例(失败率4.4%),其中,3例移位较轻,2例移位明显,与适应证选择不当、骨质疏松、攻丝过度及术后活动过早过多等有关。有局部不良反应7例(发生率6.2%),其中,较轻2例(1.8%),较重5例(4.4%);早期反应4例(3.5%),中晚期反应3例(2.7%),主要与材料成分、螺钉穿破关节、螺钉帽外露骨过多等有关。说明可吸收螺钉固定并发症与可吸收材料成分、适应证选择不当、未按手术规范操作和术后活动过早过多等多种因素有关。BACKGROUND： In some special parts of limbs, absorbable screws instead of metal screws have obtained good fixation effects, but, a few complications also appear. The causes and prevention measures of complications of absorbable screws have been reported less in literature. OBJECTIVE： To analyze the incidence, causes and prevention measures of complications of absorbable screw internal fixation. METHODS： A total of 113 cases treated with 236 absorbable screw or rod internal fixation were studied retrospectively. Among the 113 cases, limb fractures occurred in 92 cases and ligament reconstructions in21 cases. Excepted for four cases of tibial shaft fractures, the rest cases of limb fractures were cancellous bone fractures near the joints. RESULTS AND CONCLUSION： All the patients were followed-up for 12-48 months with an average of 20 months, the total incidence of complications was 10.6%.The fixation failure occurred in five cases （failure rate 4.4%）, that was related with inappropriate choice of indications, osteoporosis, over-tapping and too early or excessive activity after operation. Among the five cases of fixation failure, displacement lighter in three cases and displacement significant in two cases. Local adverse reactions occurred in seven cases （6.2% incidence rate）, that was mainly related with material composition, perforation of joint, too much outside exposure of screws. Among the seven cases of local adverse reactions, mild in two cases （1.8%） and severe in five cases （4.4%）; early reactions in four cases （3.5%） and late phase reactions in three cases （2.7%）. Complications of absorbable screws internal fixation are related with the material composition, poor choice of indication, failure to regulate the standard operation and too early or excessive activity after operation, as well as other factors.

关 键 词：骨关节植入物 骨科植入物 可吸收螺钉 金属钢板 内固定 肱骨髁骨折 挠骨小头 尺骨鹰嘴 髌骨骨折 并发症 固定失败 不良反应 

分 类 号：R318[医药卫生—生物医学工程]