Nørgaard Martin Agge, Andersen Torben Colberg, Lavrsen Michael Jarner, Borgeskov Sven
Department of Cardio-thoracic Surgery, RT 2152, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Eur J Cardiothorac Surg. 2006 Jun;29(6):920-4. doi: 10.1016/j.ejcts.2006.02.013. Epub 2006 May 3.
To evaluate the effect of wire removal on a consecutive series of patients with persistent anterior chest wall pain after median sternotomy.
Ninety-five patients receiving sternal wire removal during the period January 1994-October 2001 were included in a follow-up study. Preoperative data, data from the primary operation, the postoperative course, and the sternal wire removal were collected from patient histories. The patients were attempted contacted by telephone, and interviewed about the outcome of the wire removal.
Wire removals were performed 2.7+/-3.3 (SD) years (40 days-20 years) after the primary procedure. Wire removal appeared to occur more frequently in patients with allergies, patients receiving valve-related procedures, and patients that had been reoperated for surgical complications within the first month after the primary operation. In 79 patients, the pain was unrelated to skin affection or infection. Full follow-up was available for 71 patients. For 24 patients only partial follow-up was possible since the patients were dead (n = 19) or unreachable (n = 5). Of the patients followed up, 86% reported complete or partial relief of symptoms, while 11% reported no change in symptoms, and 3% reported worsening of symptoms after wire removal. In patients (n = 23) where symptoms appeared to be related to specific wires, only these were removed, and this approach produced as good results as for patients where all wires were removed.
The surgical results were generally good. Sternal wire removal should be offered to patients with persistent anterior chest wall pain after sternotomy, when other serious postoperative complications have been excluded.
评估取出钢丝对一系列正中开胸术后持续前胸壁疼痛患者的影响。
纳入1994年1月至2001年10月期间接受胸骨钢丝取出术的95例患者进行随访研究。从患者病史中收集术前数据、初次手术数据、术后病程及胸骨钢丝取出情况。通过电话联系患者，询问钢丝取出的结果。
初次手术后2.7±3.3（标准差）年（40天至20年）进行钢丝取出。钢丝取出在有过敏反应的患者、接受瓣膜相关手术的患者以及初次手术后第一个月内因手术并发症接受再次手术的患者中似乎更常见。79例患者的疼痛与皮肤病变或感染无关。71例患者获得了完整随访。24例患者仅能进行部分随访，原因是患者死亡（n = 19）或无法联系到（n = 5）。在接受随访的患者中，86%报告症状完全或部分缓解，11%报告症状无变化，3%报告钢丝取出后症状加重。在症状似乎与特定钢丝有关的患者（n = 23）中，仅取出这些钢丝，这种方法产生的效果与取出所有钢丝的患者相同。
手术结果总体良好。当排除其他严重术后并发症时，对于正中开胸术后持续前胸壁疼痛的患者应考虑进行胸骨钢丝取出术。
