与其他常用的植入物相比，使用先进的转子固定钉（TFNA）可能增加钉断裂的风险和早期断裂时间

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-05-08 DOI:10.1016/j.injury.2025.112410

Leevi Karjalainen , Antti AJ. Ylitalo , Miika Lähdesmäki , Antti Eskelinen , Ville M. Mattila , Jussi P. Repo

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引用次数: 0

摘要

背景：头髓钉（CMN）被广泛应用于不稳定股骨粗隆骨折的固定。2018年，Depuy Synthes粗隆固定钉-高级（TFNA）种植体在一级创伤学术中心推出。随后，由于指甲断裂的报道，临床对TFNA的使用提出了担忧。本研究的目的是探讨TFNA与其他指甲模型之间指甲断裂的风险。评估指甲失效后的长期预后。方法回顾性队列研究采用2014 - 2020年间1665例行CMN手术的患者资料。数据是从病人记录中精心挑选出来的。采用cox回归分析和logistic回归分析比较TFNA与TFN、PFNA、Gamma3、Intertan的断甲率和断甲时间。通过评估牛津髋部评分（OHS）来评估长期结果。结果头髓钉数量：TFNA 754枚（45.3%），Gamma3 462枚（27.7%），PFNA 234枚（14.1%），TFN 211枚（12.7%），Intertan 4枚（0.2%）。随访期间共有21例（1.3%）指甲断裂。TFNA断裂最多，15例（2.0%），其次是Gamma3, 5例（1.1%），PFNA 1例（0.4%）。总体而言，平均（SD）指甲断裂时间为222（148）天。而对于TFNA、Gamma3和PFNA，平均断裂时间分别为177天（110天）、292天（153天）和545天。经logistic回归分析，TFNA组与非TFNA组差异有统计学意义。TFNA组指甲断裂的优势比（OR）为2.66 [95% Ci, 1.01 ~ 6.99, p = 0.047]。指甲断裂后全髋关节置换术的平均一年OHS （SD）和再骨融合术的总OHS分别为38.6（9.8）和36.3（7.8）。结论与其他指甲模型相比，我们的研究提供了证据表明TFNA可能与指甲断裂风险增加有关。应该注意的是，种植体断裂是一种相对少见的并发症。二次手术后的长期结果与全髋关节置换术和再骨融合术相当。证据等级：四级

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Use of the trochanteric fixation nail advanced (TFNA) may increase the risk for nail breakage and early breakage time compared to other frequently used implants

Background

Cephalomedullary nails (CMN) are widely used for fixation of unstable pertrochanteric fractures. In 2018, the Depuy Synthes Trochanteric Fixation Nail - Advanced (TFNA) implant was introduced at a level I academic trauma center. Subsequently, clinical concerns were raised about the use of the TFNA due to reports of nail breakage. The purpose of this study was to investigate the risk of nail breakage between TFNA and other nail models. Long term outcomes following nail failure were evaluated.

Methods

A retrospective cohort study was conducted using data of 1665 patients who had undergone a CMN procedure between 2014 and 2020. Data were handpicked from patient records. The nail breakage and breakage time of the TFNA were compared to the TFN, PFNA, Gamma3, and Intertan using cox regression analysis and logistic regression analysis. Long term outcomes were evaluated by assessing Oxford Hip Scores (OHS).

Results

The number of cephalomedullary nails were as follows: TFNA 754 (45.3 %), Gamma3 462 (27.7 %), PFNA 234 (14.1 %), TFN 211 (12.7 %), and Intertan 4 (0.2 %). A total of 21 (1.3 %) nails broke during the follow-up period. The TFNA broke the most often with 15 cases (2.0 %), followed by the Gamma3 with five cases (1.1 %) and the PFNA with one case (0.4 %). Overall, the mean (SD) nail breakage time was 222 (148) days. However, for the TFNA, Gamma3 and PFNA, the mean breakage times were 177 days (110), 292 (153) and 545, respectively. In logistic regression analysis we observed significant difference between TFNA and non-TFNA group. The odds ratio (OR) for nail breakage in TFNA group was 2.66 [95 % Ci, 1.01–6.99, p = 0.047]. The mean (SD) one year OHS for Total Hip Arthroplasty after nail breakage and overall OHS for re-osteosynthesis was 38.6 (9.8) and 36.3 (7.8), respectively.

Conclusions

Our study provides evidence suggesting that the TFNA may be associated with an increased risk of nail breakage compared to other nail models. It should be noted that implant breakage is a relatively infrequent complication. Long-term outcomes following secondary procedures were comparable between THA and re-osteosynthesis.

Level of evidence

Level IV

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.