Ito Tsutomu, Kudo Mikihiko, Yozu Ryohei
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Ann Thorac Surg. 2008 Dec;86(6):1905-8. doi: 10.1016/j.athoracsur.2008.08.059.
Port-access minimally invasive cardiac surgery has been developed with the aim of reducing surgical invasion. We conduct port-access cardiac surgery, generally through an intercostal space. To ensure sufficient visual field, either the upper or lower rib may be divided. In the process of restoration of divided ribs, we have developed a bone fixation technique using a new osteosynthesis device by way of prevention of pseudoarthrosis.
Forty-five consecutive patients underwent right-sided anterior intercostal thoracotomy under the port-access method between July 2006 and July 2007. We used a totally resorbable osteosynthesis device (Super Fixsorb; Takiron Co., Ltd., Osaka, Japan) consisting of a mix of poly-L-lactide (PLLA) and particulate resorbable uncalcined hydroxyapatite (u-HA).
Fixation of the rib-costal cartilage was sufficiently achieved in this manner. No clinical symptoms suggestive of inflammation or infection were identified in the areas corresponding to the site of bone junction, and no patients have suffered pseudoarthrosis perioperatively and up to one year after surgery. Computed tomographic (CT) scanning clearly visualized these devices, and their attachment to the rib surfaces was confirmed in the patient who underwent CT scanning after the longest tested interval of 133 days after surgery.
In this study, the possibility was suggested that the advantages of u-HA/PLLA composite, such as early osteoconductive property and bioactive property, might beneficially affect bone fusion. We conclude that this osteosynthesis device can be applied in various fields, including cardiovascular surgery, and that its use will contribute to improvement of patients' postoperative quality of life.
端口入路微创心脏手术的发展旨在减少手术创伤。我们进行端口入路心脏手术，通常通过肋间间隙。为确保足够的视野，可能会分割上肋骨或下肋骨。在分割肋骨的修复过程中，我们开发了一种使用新型骨固定装置的骨固定技术，以预防假关节形成。
2006年7月至2007年7月期间，45例连续患者接受了端口入路法下的右侧前肋间开胸手术。我们使用了一种完全可吸收的骨固定装置（Super Fixsorb；日本大阪Takiron有限公司），其由聚-L-乳酸（PLLA）和颗粒状可吸收未煅烧羟基磷灰石（u-HA）混合而成。
通过这种方式充分实现了肋骨-肋软骨的固定。在与骨连接部位相对应的区域未发现提示炎症或感染的临床症状，并且在围手术期及术后长达一年的时间里没有患者发生假关节。计算机断层扫描（CT）清晰地显示了这些装置，并且在术后最长测试间隔133天后接受CT扫描的患者中证实了它们附着在肋骨表面。
在本研究中，提示u-HA/PLLA复合材料的优势，如早期骨传导性和生物活性，可能对骨融合产生有益影响。我们得出结论，这种骨固定装置可应用于包括心血管手术在内的各个领域，其使用将有助于改善患者的术后生活质量。
