Yeung Caleb M, Bhashyam Abhiram R, Groot Olivier Q, Merchan Nelson, Newman Erik T, Raskin Kevin A, Lozano-Calderón Santiago A
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Bone Jt Open. 2022 Aug;3(8):648-655. doi: 10.1302/2633-1462.38.BJO-2022-0092.R1.
Due to their radiolucency and favourable mechanical properties, carbon fibre nails may be a preferable alternative to titanium nails for oncology patients. We aim to compare the surgical characteristics and short-term results of patients who underwent intramedullary fixation with either a titanium or carbon fibre nail for pathological long-bone fracture.
This single tertiary-institutional, retrospectively matched case-control study included 72 patients who underwent prophylactic or therapeutic fixation for pathological fracture of the humerus, femur, or tibia with either a titanium (control group, n = 36) or carbon fibre (case group, n = 36) intramedullary nail between 2016 to 2020. Patients were excluded if intramedullary fixation was combined with any other surgical procedure/fixation method. Outcomes included operating time, blood loss, fluoroscopic time, and complications. Fisher's exact test and Mann-Whitney U test were used for categorical and continuous outcomes, respectively.
Patients receiving carbon nails as compared to those receiving titanium nails had higher blood loss (median 150 ml (interquartile range (IQR) 100 to 250) vs 100 ml (IQR 50 to 150); p = 0.042) and longer fluoroscopic time (median 150 seconds (IQR 114 to 182) vs 94 seconds (IQR 58 to 124); p = 0.001). Implant complications occurred in seven patients (19%) in the titanium group versus one patient (3%) in the carbon fibre group (p = 0.055). There were no notable differences between groups with regard to operating time, surgical wound infection, or survival.
This pilot study demonstrates a non-inferior surgical and short-term clinical profile supporting further consideration of carbon fibre nails for pathological fracture fixation in orthopaedic oncology patients. Given enhanced accommodation of imaging methods important for oncological surveillance and radiation therapy planning, as well as high tolerances to fatigue stress, carbon fibre implants possess important oncological advantages over titanium implants that merit further prospective investigation. Level of evidence: III, Retrospective study Cite this article: 2022;3(8):648-655.
由于碳纤维钉的射线可透性和良好的机械性能，对于肿瘤患者而言，它可能是钛钉的一种更优替代选择。我们旨在比较接受钛钉或碳纤维钉髓内固定治疗病理性长骨骨折患者的手术特点和短期结果。
这项单中心三级机构的回顾性配对病例对照研究纳入了72例在2016年至2020年间因肱骨、股骨或胫骨病理性骨折接受预防性或治疗性固定的患者，其中36例使用钛钉（对照组），36例使用碳纤维钉（病例组）。如果髓内固定与任何其他手术操作/固定方法联合使用，则将患者排除。结果包括手术时间、失血量、透视时间和并发症。分别使用Fisher精确检验和Mann-Whitney U检验分析分类变量和连续变量结果。
与接受钛钉的患者相比，接受碳纤维钉的患者失血量更多（中位数150毫升（四分位间距（IQR）100至250）对100毫升（IQR 50至150）；p = 0.042），透视时间更长（中位数150秒（IQR 114至182）对94秒（IQR 58至124）；p = 0.001）。钛钉组有7例患者（19%）发生植入物相关并发症，而碳纤维组有1例患者（3%）发生（p = 0.055）。两组在手术时间、手术伤口感染或生存率方面无显著差异。
这项初步研究表明，碳纤维钉在手术和短期临床方面并不逊色，支持在骨科肿瘤患者病理性骨折固定中进一步考虑使用。鉴于碳纤维植入物对肿瘤监测和放射治疗计划重要的成像方法具有更好的适应性，以及对疲劳应力的高耐受性，与钛植入物相比，碳纤维植入物具有重要的肿瘤学优势，值得进一步进行前瞻性研究。证据级别：III，回顾性研究 引用本文：2022;3(8):648-655。
