Kirbas Ahmet, Celik Sezai, Gurer Onur, Yildiz Yahya, Isik Omer
Division of Cardiovascular Surgery, Medicana Hospitals Camlica, 34764 Istanbul, Turkey.
Tex Heart Inst J. 2011;38(2):132-6.
Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite prevalent among the elderly. In this prospective study, we investigated the potential of sternal protection by use of the "sternal wrapping method" in elderly osteoporotic patients who were undergoing median sternotomy.For this study, we chose 100 elderly osteoporotic patients who were scheduled to undergo median sternotomy. During surgery, we wrapped the sternal edges with polyvinyl chloride tubing in 50 patients (group 1) and omitted the sternal wrapping in the remaining 50 patients (group 2). We then compared the groups with regard to postoperative pain, bleeding, early and late sternum-related morbidity, sternal fractures, and duration of hospitalization.Sternal wrapping was associated with fewer sternal fractures, less chest pain, and shorter hospital stays. Overall sternal morbidity was significantly less common among patients with sternal wrapping (4% vs. 20%, P = 0.03); however, the difference in individual rates for early and late dehiscence or deep sternal infection did not reach statistical significance.Sternal wrapping using polyvinyl chloride tubes provides mechanical protection and, apparently, less postoperative chest pain and shorter hospitalizations. Probably, it reduces sternum-related complications, particularly in high-risk patients. Its benefits, however, should be confirmed in larger studies.
骨质疏松症是正中开胸术后与胸骨相关发病的主要危险因素，在老年人中相当普遍。在这项前瞻性研究中，我们调查了在接受正中开胸术的老年骨质疏松患者中使用“胸骨包裹法”进行胸骨保护的可能性。
在本研究中，我们选择了100例计划接受正中开胸术的老年骨质疏松患者。手术过程中，我们用聚氯乙烯管包裹50例患者的胸骨边缘（第1组），其余50例患者不进行胸骨包裹（第2组）。然后我们比较两组患者术后疼痛、出血、早期和晚期与胸骨相关的发病率、胸骨骨折及住院时间。
胸骨包裹与较少的胸骨骨折、较轻的胸痛和较短的住院时间相关。接受胸骨包裹的患者总体胸骨发病率明显较低（4%对20%，P = 0.03）；然而，早期和晚期切口裂开或深部胸骨感染的个体发生率差异未达到统计学意义。
使用聚氯乙烯管进行胸骨包裹可提供机械保护，显然还可减轻术后胸痛并缩短住院时间。可能它能减少与胸骨相关的并发症，尤其是在高危患者中。然而，其益处应在更大规模的研究中得到证实。
