Zoccali Carmine, Attala Dario, Pugliese Mattia, di Uccio Alessandra Scotto, Baldi Jacopo
Oncological Orthopaedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
Orthopedics and Traumatology School, Department of Surgery, Sapienza University of Rome, Piazzale Aldo Moro 3/5, 00100, Rome, Italy.
BMC Musculoskelet Disord. 2021 Jan 11;22(1):63. doi: 10.1186/s12891-020-03927-6.
Locked titanium nails are considered the reference treatment for metastatic bone lesions of the humerus in patients with aggressive histotypes, high risk of fracture or when estimated survival is lower than 6 months.Nevertheless, they are responsible for CT and MRI artifacts which interfere with postoperative radiotherapy and follow-up.The IlluminOss® is an intramedullary stabilization system which is introduced inside the humeral canal in a deflated state, and is then distended with a monomer which hardens after exposure to blue light,stabilizing the segment; it does not cause artifacts, allowing easier and more effective radiotherapy and follow-up. The aim of this study is to report our experience, indications, possible advantages and limitations of this stabilization system at 24 months of minimum follow-up in a series of 12 patients affected by pathological fractures or impending fractures of the humerus.
This is a retrospective case-series that included all patients who underwent surgery with the IlluminOss® Photodynamic Bone Stabilization System for pathological osteolyses and fractures of the humerus. Intraoperative and postoperative complications were valued.
12 patients and 13 procedures were included in the study. All surgeries were performed without intraoperative complications. No early postoperative complications were noted. The wounds healed in all cases and stitches were removed at two weeks from surgery, so the patients were able to perform chemotherapy after three weeks. All patients except one had a painless active range of motion which reached 90°.The VAS score was 7 preoperatively and 2.6 at one month from surgery. Pain relief was also associated to radiotherapy and chemotherapy. Unfortunately, two nail ruptures were reported at 4 and 12 months of follow-up. No artifacts were noted in the postoperative CT scans so the radiotherapy plans were easily performed without the need of dose compensation.
The IlluminOss® intramedullary stabilization system can provide primary stability in humeral fractures and impending fractures;the surgical technique is easy and minimally invasive.Moreover,it does not present artifacts at postoperative imaging,probably giving a better chance to perform prompt radiotherapy and chemotherapy.However, randomized clinical studies are necessary to verify its potential strength and if precocious adjuvant radio- and chemotherapy are associated to a reduction of the local progression rate.
对于组织学类型侵袭性高、骨折风险高或预计生存期低于6个月的肱骨转移性骨病变患者，锁定钛钉被视为标准治疗方法。然而，它们会导致CT和MRI伪影，干扰术后放疗和随访。IlluminOss®是一种髓内稳定系统，在放气状态下被引入肱骨髓腔，然后用一种单体膨胀，该单体在暴露于蓝光后硬化，从而稳定节段；它不会产生伪影，使放疗和随访更容易、更有效。本研究的目的是报告我们在一系列12例患有肱骨病理性骨折或即将发生骨折的患者中，对该稳定系统进行至少24个月随访的经验、适应证、可能的优点和局限性。
这是一项回顾性病例系列研究，纳入了所有接受IlluminOss®光动力骨稳定系统治疗肱骨病理性骨质溶解和骨折的患者。评估术中及术后并发症。
本研究纳入12例患者，共进行了13次手术。所有手术均无术中并发症。术后未发现早期并发症。所有伤口均愈合，术后两周拆线，因此患者在三周后能够进行化疗。除1例患者外，所有患者的无痛活动范围均达到90°。术前VAS评分为7分，术后1个月为2.6分。疼痛缓解也与放疗和化疗有关。遗憾的是，随访4个月和12个月时报告了2例钉断裂。术后CT扫描未发现伪影，因此放疗计划无需剂量补偿即可轻松进行。
IlluminOss®髓内稳定系统可为肱骨骨折和即将发生的骨折提供初步稳定性；手术技术简单且微创。此外，它在术后成像中不会出现伪影，可能为及时进行放疗和化疗提供更好的机会。然而，需要进行随机临床研究以验证其潜在优势，以及早期辅助放疗和化疗是否与局部进展率的降低相关。
