Unpredictable Migration of Kirschner Pin: Report of Four Cases

未可預知之柯式鋼針移位：四病例報告

張櫻霖(Ing-Lin Chang)；胡仲行(Chung-Hsing Hu)；于振東(Chen-Tung Yu)；潘文惇(Moon-Dan Poon)

移位 ； 柯式鋼針 ； migration ； kirschner pin

The Changhua Journal of Medicine

6卷3期（2001 / 07 / 01）

184 - 188

英文

對骨折及關節脫臼之治療，鋼針及鋼絲仍然是簡單而有用的內固定術工具之一。但有些報告提出因鋼針移位造成心臟、肺臟、脊髓損傷的嚴重併發症。在我們的病患中也有未可預知之鋼針移位的情況。 1998年5月至2000年5月，四位病患各因肱骨頸骨折，髕骨骨折及尺骨幹骨折而接受骨折復位及鋼針內固定。這些病患的骨折在門診都已骨癒合，但固定鋼針卻發生未可預期之移位情形。參考27篇相關文獻並提出探討報告。 這些移位的鋼針都在移動式透視X光機輔助下拔除。每日重複之肌肉運動、重力、微血管及呼吸等作用被認為是造成鋼針移動的原因。但確實的原因仍不是很清楚。甚至採用有螺紋之史戴曼式(Steinmann)針或末端彎曲之鋼針仍無法避免鋼針移位。使用一些避免移動之裝置可用來避免鋼針之移位。但最好之方法則是定期的追蹤病人並在骨折臨床癒合時及早拔除固定鋼針。

Pins and wires are among the simplest yet most effective tools used in the management of fractures and dislocations; however, several serious complications resulting from pin migration to vital structures, such as the heart, lungs or spinal cord were reported. Our study also shows the unpredictable nature of pin migration. From May 1998 to May 2000, four patients with humeral neck, patella, or ulnar shaft fractures were included in this study. All of these fractures were treated with Kirschner pin (K-pin) fixation. All fracture fixations were followed up in our outpatient department where we observed the unpredictable nature of K-pin migration. We used a C-arm image intensifier to guide the uneventful removal of the migrated pins. Repetitive daily muscular movement, the force of gravity, capillary action, and respiratory action are all considered to be the causes of pin migration; however, the primary cause remains obscure. Even pre-bent K-pins or threaded Steinmann pins are likely to migrate. Restraining devices may be used to avoid pin migration; however, we found the most effective method of preventing pin migration is by close patient follow-up and immediate pin removal upon achieving fracture union.