钢板的螺孔是不是太多了？
Are there too many screw holes in plates for fracture fixation？
BMC Surgery volume 17, Article number: 46 (2017)
钢板的螺孔是不是太多了？
Abstract
Background
Implant breakage after the fixation of traumatic fractures is rare; however, when it occurs, it is debilitating使衰弱 for the patients and a challenge for surgeons. The purpose of this study was to analyze and identify the independent risk factors for implant breakage of traumatic fractures treated with plate osteosynthesis接骨术.
Methods
We reviewed the medical records of patients with a fracture to any part of their four extremities四肢, clavicle, hand or foot, who underwent surgical plate osteosynthesis from January 2005 to January 2015, and who sustained承受 a subsequent随后的 implant breakage. Kaplan–Meier univariate and multivariate Cox regressions回归 （Kaplan-Meier单变量和多变量Cox回归分析） were performed to identify independent associations独立相关性 of potential risk factors for implant breakage in this cohort.
Results
We identified 168 patients who underwent plate osteosynthesis surgery and had subsequent internal fixator breakage. The mean patient age was 40.63 ± 16.71 years (range, 3 to 78 years), with 72.0% (121) males and 28.0% (47) females. The average time between surgery and implant breakage was 12.85 ± 12.42 months (range, 1 to 60 months). In the final regression回归 model, we show that inserting screws close to the fracture line is an independent predictive risk factor for implant breakage (HR, 2.165, 95%CI, 1.227 to 3.822; P = 0.008).
Conclusions
We found that inserting screws close to the fracture line is related to an increased risk of internal fixator breakage in patients treated with plate osteosynthesis after fracture. Plates with additional holes likely lead to an increased risk of implant breakage, presumably大概，可能 because surgeons cannot resist inserting extra screws into the holes adjacent to the fracture line, which reduces the stiffness刚度 of the plate. We have addressed this problem by designing a plate without holes adjacent to the fracture line.
百度翻译：
摘要
背景：外伤性骨折固定后种植体断裂是罕见的，但一旦发生，对患者来说是一种衰弱，对外科医生来说是一种挑战。本研究的目的是分析和确定钢板接骨术治疗外伤性骨折种植体断裂的独立危险因素。
方法：我们回顾了2005年1月至2015年1月接受外科钢板接骨术的四肢骨折患者的医疗记录，包括锁骨、手或脚，以及随后发生植入物断裂的患者。采用Kaplan-Meier单变量和多变量Cox回归分析，确定种植体断裂潜在危险因素的独立相关性。
结果：我们确定了168例患者，他们接受了钢板接骨术，随后发生了内固定器断裂。患者平均年龄40.63±16.71岁（3～78岁），其中男性72.0%（121人），女性28.0%（47人）。手术至种植体断裂的平均时间为12.85个月（1-60个月）。在最后的回归模型中，我们显示在骨折线附近插入螺钉是种植体断裂的独立预测风险因素（HR，2.165，95%CI，1.227至3.822；P = 0.008）。
结论：我们发现在骨折线附近插入螺钉与骨折后钢板接骨术患者内固定器断裂风险增加有关。带有额外孔的钢板可能导致种植体断裂的风险增加，这可能是因为外科医生无法抗拒在骨折线附近的孔中插入额外的螺钉，从而降低了钢板的硬度。我们通过设计一个在断裂线附近没有孔的板来解决这个问题。