Boiselle P M, Mansilla A V, Fisher M S, McLoud T C
Department of Diagnostic Imaging, Temple University Hospital, Philadelphia, PA 19140, USA.
AJR Am J Roentgenol. 1999 Sep;173(3):777-80. doi: 10.2214/ajr.173.3.10470922.
The purpose of this study is to assess the frequency of various sternal wire abnormalities on chest radiographs of patients with sternal dehiscence and to determine the role of radiography in detecting or confirming this complication.
We used our computerized hospital information system to identify all patients with a diagnosis of sternal dehiscence from January 1993 through June 1998. Clinical data were obtained by retrospective chart review. A chest radiograph from the date of diagnosis was compared with the first postoperative radiograph obtained after median sternotomy. Each radiograph was retrospectively reviewed by two radiologists who assessed three sternotomy wire abnormalities: displacement (offset of one or more wires in relation to others in the vertical row), rotation (alteration in the axis of a wire compared with its orientation on a baseline radiograph), and disruption (unraveling or fracture of a wire). We also reviewed a series of postoperative radiographs in a group of matched controls who had an uneventful postoperative course with no clinical evidence of dehiscence.
The study cohort included 19 patients, 13 men and six women, who were 49-84 years old (mean, 66 years). The chest radiographs revealed sternal wire abnormalities in 17 (89%) of 19 patients with sternal dehiscence, including displacement in 16 (84%) of 19 patients, rotation in 10 (53%) of 19 patients, and disruption in four (21%) of 19 patients. The mean number of displaced wires per patient was 2.3 (range, 1-5). The mean distance of maximal displacement was 20 mm (range, 6-45 mm). Radiographic abnormalities preceded the clinical diagnosis in 13 (68%) of 19 patients. We observed no case of sternal wire displacement, rotation, or disruption in the control group.
Sternal wire abnormalities, most notably displacement, are present in most patients with sternal dehiscence; radiographic abnormalities precede the clinical diagnosis in most cases.
本研究旨在评估胸骨裂开患者胸部X线片上各种胸骨钢丝异常的发生率，并确定X线检查在检测或证实这一并发症中的作用。
我们利用计算机化医院信息系统，识别出1993年1月至1998年6月期间所有诊断为胸骨裂开的患者。通过回顾病历获取临床资料。将诊断日期的胸部X线片与正中胸骨切开术后获得的首张术后X线片进行比较。两名放射科医生对每张X线片进行回顾性评估，评估三种胸骨切开钢丝异常情况：移位（垂直排中一根或多根钢丝相对于其他钢丝的偏移）、旋转（钢丝轴线与其在基线X线片上的方向相比发生改变）和断裂（钢丝解开或断裂）。我们还回顾了一组术后过程顺利且无裂开临床证据的匹配对照组的一系列术后X线片。
研究队列包括19例患者，13例男性和6例女性，年龄49 - 84岁（平均66岁）。胸部X线片显示，19例胸骨裂开患者中有17例（89%）存在胸骨钢丝异常，其中19例患者中有16例（84%）出现移位，19例患者中有10例（53%）出现旋转，19例患者中有4例（21%）出现断裂。每位患者移位钢丝的平均数量为2.3根（范围为1 - 5根）。最大移位的平均距离为20毫米（范围为6 - 45毫米）。19例患者中有13例（68%）的X线异常先于临床诊断出现。对照组未观察到胸骨钢丝移位、旋转或断裂的病例。
大多数胸骨裂开患者存在胸骨钢丝异常，最显著的是移位；在大多数情况下，X线异常先于临床诊断出现。
