Benjamin D Pesante, Byron A Ward, Stephen C Stacey, Joshua A Parry
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引用次数: 0
Abstract
Introduction: Symptomatic interlocking screws are common after intramedullary nail fixation of tibia fractures. Low-profile headless interlocking screws recently became available and could potentially reduce the rate of symptomatic screws. The purpose of this study was to compare the rate of symptomatic screws and screw removals between these screw types.
Methods: A retrospective review identified patients with tibia shaft fractures treated with tibia intramedullary nails between August 1, 2018 to September 1, 2023 by 11 surgeons. Low-profile headless interlocking screws became available on June 28, 2021 and were routinely used thereafter. Patients treated with low-profile headless versus standard headed interlocking screws were compared in terms of symptomatic screws, defined as a patient reporting pain or discomfort at the site of a screw head in clinical documentation, symptomatic screw removals, screw failure (breakage or backout), and procedures to promote bone union.
Results: Overall, 79 patients were included in the analysis: 33 patients treated with 144 headless screws and 46 patients treated with 187 standard screws. The median patient age was 35 years, and a majority were male (68.4%, n = 54). The median follow-up length was 8.5 months (interquartile range 5.5 to 8.8 months). The headless screw group, compared with standard screw group, did not differ in age, injury mechanism severity, open fracture classification, tobacco use, American Society of Anesthesiologists classification >2, number of interlocking screws used, or follow-up time (P > 0.05). The headless screw group was less likely to have symptomatic screws (0.0% vs. 23.9%; P = 0.002), less likely to have symptomatic screw removal (0.0% vs. 13.0%; P = 0.03), and had no difference in procedures to promote bone union (10.0% vs. 6.8%; P = 0.68) or screw backout (0.0% vs. 4.4%; P = 0.50).
Discussion: Standard headed interlocking screws were symptomatic in 23.9% of patients and 13.0% underwent symptomatic screw removal. In comparison, no patients treated with low-profile headless interlocking screws had symptomatic screws.
导言：胫骨骨折髓内钉固定后，无症状交锁螺钉很常见。最近推出的低剖面无头联锁螺钉有可能降低无症状螺钉的使用率。本研究旨在比较这些螺钉类型的无症状螺钉和螺钉取出率：一项回顾性研究确定了2018年8月1日至2023年9月1日期间由11名外科医生使用胫骨髓内钉治疗的胫骨轴骨折患者。低位无头锁定螺钉于 2021 年 6 月 28 日上市，此后被常规使用。对使用低剖面无头螺钉与标准有头联锁螺钉治疗的患者进行了比较，比较的内容包括有症状的螺钉（定义为患者在临床文件中报告螺钉头部位疼痛或不适）、有症状的螺钉移除、螺钉失效（断裂或后退）以及促进骨结合的手术：共有79名患者参与了分析：33名患者接受了144枚无头螺钉的治疗，46名患者接受了187枚标准螺钉的治疗。患者年龄中位数为 35 岁，大部分为男性（68.4%，n = 54）。中位随访时间为8.5个月（四分位间范围为5.5至8.8个月）。与标准螺钉组相比，无头螺钉组在年龄、损伤机制严重程度、开放性骨折分类、吸烟情况、美国麻醉医师协会分类>2、使用联锁螺钉数量或随访时间方面均无差异（P>0.05）。无头螺钉组出现无症状螺钉的几率较低（0.0% vs. 23.9%; P = 0.002），出现无症状螺钉移除的几率较低（0.0% vs. 13.0%; P = 0.03），促进骨结合的手术（10.0% vs. 6.8%; P = 0.68）或螺钉后退（0.0% vs. 4.4%; P = 0.50）没有差异：讨论：23.9%的患者在使用标准带头联锁螺钉后出现症状，13.0%的患者在出现症状后将螺钉取出。相比之下，使用扁平无头联锁螺钉治疗的患者中没有人出现螺钉症状：证据级别：3级，诊断
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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