Schimmer C, Reents W, Elert O
Zentrum Operative Medizin, Klinik und Poliklinik für Herz-, und Thoraxchirurgie der Universität Würzburg, Würzburg, Germany.
Thorac Cardiovasc Surg. 2006 Sep;54(6):408-13. doi: 10.1055/s-2006-924193.
Sternal instability and mediastinitis are rare but serious complications following cardiac surgery with median sternotomy.
This study presents the results of a questionnaire, which was sent to all 79 German surgical heart centers. The conventional sternal closure technique, the parameters considered to be risk factors for sternal instability, and the surgical strategy in the presence of risk factors were determined. In addition, a literature research with the key words "sternal closure technique" and "sternal dehiscence" was performed.
Conventional closure of primary sternotomy is done using many different methods, most often with surgical steel sutures (87 %) passed trans/peristernally (64 %). An osteoporotic or fractured sternum (70 x), and obesity (31 x) were the most frequently cited risk factors. The preferred osteosynthetic procedure for patients with an increased risk for sternal instability was the method of Robicsek (48 x).
There is no uniform osteosynthetic method for primary sternal closure and there is substantial variation in the perception of risk factors for sternal instability and possible surgical consequences among the surgical heart centers in Germany.
胸骨不稳定和纵隔炎是正中开胸心脏手术后罕见但严重的并发症。
本研究展示了一份问卷的结果，该问卷被发送给了德国所有79个心脏外科中心。确定了传统的胸骨闭合技术、被认为是胸骨不稳定危险因素的参数以及存在危险因素时的手术策略。此外，还进行了一项以“胸骨闭合技术”和“胸骨裂开”为关键词的文献研究。
原发性胸骨切开术的传统闭合方法多种多样，最常用的是经胸骨/胸骨周围穿过的外科钢缝线（87%）（64%）。骨质疏松或骨折的胸骨（70次）和肥胖（31次）是最常被提及的危险因素。对于胸骨不稳定风险增加的患者，首选的骨固定方法是罗比克塞克法（48次）。
对于原发性胸骨闭合，没有统一的骨固定方法，德国心脏外科中心对胸骨不稳定危险因素及可能的手术后果的认知存在很大差异。
