螺钉取出困难应对方法合理性和手术失误的研究  

The rationality and surgical errors in countermeasures against difficult removal of screws

作　　者：宋升 魏长宝 沈奕雯 张樱严 陆叶 王鹏 殷渠东 Song Sheng;Wei Changbao;Shen Yiwen;Zhang Yingyan;Lu Ye;Wang Peng;Yin Qudong(Department of Orthopaedics,Wuxi NO.9 People's Hospital Affiliated to Suzhou University,Jiangsu 214062,China;Operation Room,Wuxi NO.9 People's Hospital Affiliated to Suzhou University,Jiangsu 214062,China)

机构地区：[1]苏州大学附属无锡市第九人民医院骨科,无锡214062 [2]苏州大学附属无锡市第九人民医院手术室,无锡214062

出　　处：《中华创伤骨科杂志》2023年第10期905-909,共5页Chinese Journal of Orthopaedic Trauma

基　　金：2020年度"太湖人才计划"顶尖医学专家团队项目(THTP-10);无锡市适宜技术推广项目(T201938);无锡市第九人民医院"优博"项目(YB-02);无锡市科技局课题(Y20212057,Y20212014)。

摘　　要：目的探讨术中发生螺钉取出困难时应对方法的合理性和手术失误情况,为制定标准化技术流程提供参考。方法回顾性分析2018年1月至2022年5月苏州大学附属无锡市第九人民医院骨科内固定取出术中发生螺钉取出困难99例患者资料。男62例,女37例;年龄(38.8±14.7)岁;内固定置入时间7个月至11年。将术前准备不充分、应对方法与适应证不符合、不符合最小损伤和先简单后复杂的科学原则等视为应对方法不合理;将术中发生不必要损伤、取出失败以及出现与手术相关的并发症视为手术失误。分析应对方法不合理和手术失误的发生,以及二者的关系。结果99例患者中92例成功取出,7例取出失败。26.3%(26/99)的患者螺钉取出困难患者存在应对方法不合理,28.3%(28/99)的患者螺钉取出困难患者存在手术失误。在存在应对方法不合理患者中,手术失误发生率为53.9%(14/26),显著高于无不合理患者的19.2%(14/73),差异有统计学意义(χ^(2)=11.360,P<0.001);在存在手术失误患者中,应对方法不合理的发生率为64.3%(18/28),显著高于无手术失误患者的11.3%(8/71),差异有统计学意义(χ^(2)=29.148,P<0.001);在取出失败患者中,存在应对方法不合理的发生率为85.7%(6/7),显著高于成功取出患者的21.7%(20/92),差异有统计学意义(χ^(2)=13.748,P<0.001)。结论应对方法不合理与手术失误、取出失败有一定关系,应对方法不合理因素所占比例越高,发生手术失误可能性越大。Objective To investigate the rationality and surgical errors in countermeasures against difficult removal of screws so as to provide reference for standardization of technical procedures.Methods A retrospective study was conducted to analyze the data of 99 patients who had encountered difficult removal of screws in operative removal of internal fixation at Department of Orthopaedics,Wuxi NO.9 People's Hospital Affiliated to Suzhou University from January 2018 to May 2022.There were 62 males and 37 females with an average age of 38.8±14.7 years.Their internal fixation time ranged from 7 months to 11 years.The irrationality was defined as insufficient preoperative preparation or a countermeasure that failed to follow the surgical indications or scientific principles of minimal injury or priority of simplicity.A surgical error was defined as unnecessary injury,failed removal or complications related to operation.Cases of irrationality and surgical errors were analyzed to find associations between them.Results The operative removal was successful in 92 cases and failed in 7 cases.Of the patients who experienced difficult removal of screws,irrationality was found in 26.3%(26/99)and a surgical error or errors occurred in 28.3%(28/99).In the patients with countermeasure irrationality,the incidence of surgical errors was 53.9%(14/26)while in those without countermeasure irrationality,the incidence of surgical errors was 19.2%(14/73),showing a statistically significant difference(χ^(2)=11.360,P<0.001).In the patients with surgical errors,the incidence of countermeasure irrationality was 64.3%(18/28)while in the patients without surgical errors,the incidence of countermeasure irrationality was and 11.3%(8/71),showing a statistically significant difference(χ^(2)=29.148,P<0.001).In the patients with failed removal,the rate of countermeasure irrationality was 85.71%(6/7)while in those with successful removal,the rate of countermeasure irrationality was 21.7%(20/92),showing a statistically significant difference(χ^(2)=13.7

关 键 词：内固定器 骨钉 装置取出 取出困难 合理性 手术失误 

分 类 号：R687.3[医药卫生—骨科学]