背景:钛植入物通常用于骨科创伤的手术固定,与不锈钢植入物相比有很多好处。尽管有这些好处,一些骨科医生仍然犹豫使用钛植入物,由于担心未来植入物移除困难,考虑到冷焊和螺钉剥离。这项研究的目的是评估与钛板和螺钉植入物移除相关的困难。
方法:这是来自大型医院系统的回顾性病例系列。从2017年到2020年,患者使用当前程序术语(CPT)代码20680进行识别。如果患者从上肢或下肢移除钛板和螺钉,至少18岁,认为骨骼成熟。钛板/螺钉移除的难易程度通过评估植入物冷焊接来确定。螺钉断裂,剥离螺钉,以及对高级工具的需求(螺钉拆卸套件,trephine,毛刺)。
结果:确定了157例患者,平均年龄54岁,59%为女性。总共移除1274颗螺钉:14颗(1.1%)被剥离,8人(0.6%)进行了冷焊接,42(3.3%)松动,和13(1.0%)被打破。总共取出183个平板,15例(8.2%)有需要切除的骨过度生长。12(7.6%)程序复杂,需要使用先进的工具。体内植入时间明显延长后,发生了复杂的植入物移除手术(平均3.7vs.1.1年,p=0.036),与更年轻的年龄有关,更有可能发生在下肢手术中(p=0.034),并花费了明显更长的时间(95vs.42分钟,p<0.001)。
结论:尽管关注钛植入物,我们发现螺钉剥离率很低,破损,和冷焊接在拆卸过程中。然而,157例手术中有7.6%需要额外的工具,而不仅仅是螺丝刀,需要额外的手术时间.此信息允许治疗外科医生计划在钛植入物用于固定时移除植入物。
方法:IV.
BACKGROUND: Titanium implants are commonly used for surgical fixation in orthopedic trauma, and have many benefits compared to stainless steel implants. Despite these benefits, some orthopedic surgeons remain hesitant to use titanium implants due to concerns of difficulty with future implant removal, given concerns with cold-welding and
screw strippage. The objective of this study was to assess difficulties associated with titanium plate and
screw implant removal.
METHODS: This is a retrospective case series from a large hospital system. Patients were identified using Current Procedural Terminology (CPT) code 20,680 from 2017 to 2020. Patients were included if they had removal of titanium plate and screws from the upper or lower extremity, were at least18 years of age, and considered skeletally mature. The ease of titanium plate/
screw removal was determined by assessing for implant cold-welding, broken screws, stripped screws, and the need for advanced tools (
screw removal set, trephine, burr).
RESULTS: 157 patients were identified, with a mean age of 54 years and 59 % female. In total 1274 screws were removed: 14 (1.1 %) were stripped, 8 (0.6 %) were cold-welded, 42 (3.3 %) were loose, and 13 (1.0 %) were broken. 183 plates were removed in total, and 15 (8.2 %) had bone overgrowth that required removal. 12 (7.6 %) procedures were complicated and required the use of advanced tools. Complicated implant removal operations occurred after significantly longer in vivo implant time (mean of 3.7 vs. 1.1 years, p = 0.036), were associated with a younger age, were more likely to occur in lower extremity procedures (p = 0.034), and took significantly longer time for removal (95 vs. 42 min, p < 0.001).
CONCLUSIONS: Despite concerns with titanium implants, we found a low rate of
screw strippage, breakage, and cold welding during the removal process. However, 7.6 % of the 157 surgeries required additional tools other than just a screwdriver, and needed additional operative time. This information allows treating surgeons to plan for implant removal when titanium implants have been used for fixation.
METHODS: IV.