Pala Elisa, Procura Alberto, Trovarelli Giulia, Berizzi Antonio, Ruggieri Pietro
1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy.
EFORT Open Rev. 2022 Aug 4;7(8):611-617. doi: 10.1530/EOR-22-0001.
The aim of this study is to compare titanium vs carbon fiber intramedullary (IM) nailing in terms of response to radiotherapy, local control of the disease, time of surgery, fluoroscopy exposure, and complications.
From 2015 to 2021, 52 impending or pathologic fractures were treated with IM nailing in 47 patients: 18 males and 29 females with a mean age of 73. Titanium nails were used in 27 cases: femur (17 cases), humerus (8 cases), and tibia (2 cases). Carbon fiber nails were used in 25 cases: femur (17 cases), humerus (7 cases), and tibia (1 case).
At a mean follow-up of 8.4 months, most patients died from the disease (63.4%). Fracture healing without osteolysis progression was present in 52% of titanium nailing at a mean time of 6 months and in 53% of carbon fiber nails at a mean time of 4.6 months. No statistically significant difference has been shown in terms of healing (P = 0.5), intraoperative fluoroscopy (P = 0.7), and time of surgery in femoral nailing (P = 0.6), while a significantly lower surgical time for carbon fiber humeral nailing (P = 0.01) was found. Two breakages of carbon fiber femoral nails were observed, and both were treated with revision with modular tumor megaprosthesis.
Our results suggest that surgical time and fluoroscopy exposure are not longer for carbon fiber nails compared to titanium ones. Healing seems to be faster in carbon fiber nails. Further clinical studies are needed to clarify the long-term outcomes of these implants.
本研究旨在比较钛合金与碳纤维髓内钉在放疗反应、疾病局部控制、手术时间、透视暴露及并发症方面的差异。
2015年至2021年，47例患者的52处临危或病理性骨折接受了髓内钉治疗，其中男性18例，女性29例，平均年龄73岁。27例使用钛钉，包括股骨（17例）、肱骨（8例）和胫骨（2例）。25例使用碳纤维钉，包括股骨（17例）、肱骨（7例）和胫骨（1例）。
平均随访8.4个月时，大多数患者死于疾病（63.4%）。钛钉组52%的患者骨折愈合且无骨质溶解进展，平均时间为6个月；碳纤维钉组为53%，平均时间为4.6个月。在愈合（P = 0.5）、术中透视（P = 0.7）及股骨钉手术时间（P = 0.6）方面未显示出统计学显著差异，但发现碳纤维肱骨钉的手术时间显著更短（P = 0.01）。观察到2例碳纤维股骨钉断裂，均采用模块化肿瘤假体翻修治疗。
我们的结果表明，与钛钉相比，碳纤维钉的手术时间和透视暴露时间并不更长。碳纤维钉的愈合似乎更快。需要进一步的临床研究来阐明这些植入物的长期效果。
