Oto Takahiro, Venkatachalam Ramkumar, Morsi Yos S, Marasco Silvana, Pick Adrian, Rabinov Marc, Rosenfeldt Franklin
Department of Cardiothoracic Surgery, Heart and Lung Transplant Unit, The Alfred Hospital, Monash University, Melbourne, Australia.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):218-24. doi: 10.1016/j.jtcvs.2007.03.003.
A high incidence of failure of transverse thoracosternotomy closure, involving the loops of wire cutting through the sternum, remains a significant morbidity after bilateral lung transplantation. We postulated that placing peristernal wires inside the usual longitudinal wires could prevent the longitudinal wires from cutting through the sternum. The aims of this study were to investigate the biomechanical and clinical efficacy of the proposed reinforced sternal closure technique.
In vitro, 24 artificial sternal models were wired with the reinforced or conventional wiring techniques and were tested either by means of longitudinal distraction or anterior-posterior shear (n = 6 per group). In vivo, the 6-month outcomes of 70 bilateral lung transplantations, including 27 reinforced and 43 conventional wiring techniques, were assessed.
Reinforced wiring was stronger than conventional wiring for both longitudinal distraction (yield load: 585 +/- 60 vs 334 +/- 21 N [P = .03]; maximum load: 807 +/- 60 vs 525 +/- 34 N [P = .03]; postyield stiffness: 91.0 +/- 22.0 vs 32.8 +/- 11.8 N/mm [P = .04]) and anterior-posterior shear (yield load: 405 +/- 9 vs 364 +/- 16 N [P = .03]; postyield stiffness: 47.4 +/- 6.1 vs 27.5 +/- 5.1 N/mm [P = .04]). In multivariate analysis, the use of the conventional wiring technique (odds ratio, 5.38; P = .04) and osteoporosis (odds ratio, 18.31; P = .0005) were significant risk factors associated with sternal dehiscence. In the patients with osteoporosis (n = 25), the incidence of sternal dehiscence in the reinforced wiring group (4/16 [25%]) was significantly lower than that in the conventional wiring group (7/9 [78%], P = .02).
Osteoporosis is a significant risk factor for sternal dehiscence after bilateral lung transplantation. The new reinforced sternal wiring technique provides biomechanically superior fixation of the sternum and clinically reduces the incidence of sternal dehiscence in high-risk osteoporotic patients undergoing bilateral lung transplantation.
双侧肺移植术后，经胸骨横断切开闭合术失败的发生率较高，其中包括钢丝环切割胸骨，这仍是一个严重的发病问题。我们推测，在通常的纵向钢丝内放置胸骨旁钢丝可防止纵向钢丝切割胸骨。本研究的目的是调查所提出的强化胸骨闭合技术的生物力学和临床疗效。
在体外，对24个人工胸骨模型采用强化或传统的钢丝固定技术进行钢丝固定，并通过纵向牵张或前后剪切试验（每组n = 6）。在体内，评估70例双侧肺移植的6个月结果，其中包括27例采用强化钢丝固定技术和43例采用传统钢丝固定技术。
对于纵向牵张（屈服载荷：585±60 vs 334±21 N [P = 0.03]；最大载荷：807±60 vs 525±34 N [P = 0.03]；屈服后刚度：91.0±22.0 vs 32.8±11.8 N/mm [P = 0.04]）和前后剪切（屈服载荷：405±9 vs 364±16 N [P = 0.03]；屈服后刚度：47.4±6.1 vs 27.5±5.1 N/mm [P = 0.04]），强化钢丝固定均比传统钢丝固定更强。在多变量分析中，采用传统钢丝固定技术（比值比，5.38；P = 0.04）和骨质疏松症（比值比，18.31；P = 0.0005）是与胸骨裂开相关的显著危险因素。在骨质疏松症患者（n = 25）中，强化钢丝固定组的胸骨裂开发生率（4/16 [25%]）显著低于传统钢丝固定组（7/9 [78%]，P = 0.02）。
骨质疏松症是双侧肺移植术后胸骨裂开的一个显著危险因素。新的强化胸骨钢丝固定技术在生物力学上提供了更好的胸骨固定，并在临床上降低了接受双侧肺移植的高危骨质疏松症患者的胸骨裂开发生率。
