Department of Cardiothoracic Surgery, Ozel Ege Hospital, Denizli, Turkey.
Ann Thorac Surg. 2011 Aug;92(2):638-41. doi: 10.1016/j.athoracsur.2011.04.034. Epub 2011 Jun 25.
Sternal dehiscence is a serious and potentially devastating complication after median sternotomy, especially in diabetic obese patients. The optimal technique for sternal closure is unclear in these patients.
The purpose of this prospective randomized study was to compare the incidence of sternal dehiscence after prophylactic sternal weave and figure-of-eight suturing in diabetic obese patients undergoing coronary artery bypass grafting (CABG). The patients were randomly assigned to group A (figure-of-eight closure; n=75) or group B (sternal weave closure; n=75).
There were 8 cases of sternal dehiscence documented: 7 in group A and 1 in group B. In group A, 5 patients had noninfectious sternal dehiscence and 2 patients underwent reoperation because of sternal dehiscence with mediastinitis. Also, 1 of the noninfected patients had deep-seated pain with a feeling of bony crepitus and needed reoperation. The other 4 patients in group A and 1 patient with noninfectious sternal dehiscence in group B were given chest binder support. Pain and bony crepitus decreased in the follow-up period of 1 year. Sternal dehiscence rates were 9.3% in group A and 1.3% in group B. Sternal dehiscence was significantly lower in group B (p<0.05).
Prophylactic sternal weave closure of median sternotomy reduces morbidity from sternal dehiscence in diabetic obese patients undergoing CABG.
胸骨裂开是正中胸骨切开术后一种严重且潜在的破坏性并发症，尤其是在糖尿病肥胖患者中。这些患者的胸骨闭合最佳技术尚不清楚。
本前瞻性随机研究的目的是比较预防性胸骨编织和 8 字缝合在接受冠状动脉旁路移植术（CABG）的糖尿病肥胖患者中预防胸骨裂开的发生率。患者被随机分配到 A 组（8 字闭合；n=75）或 B 组（胸骨编织闭合；n=75）。
有 8 例胸骨裂开记录：A 组 7 例，B 组 1 例。在 A 组中，5 例发生非感染性胸骨裂开，2 例因胸骨裂开合并纵隔炎而行再次手术。此外，1 例非感染患者有深部疼痛，有骨擦感，需要再次手术。A 组的其他 4 例和 B 组的 1 例非感染性胸骨裂开患者均给予胸带支持。疼痛和骨擦感在 1 年的随访期内减轻。A 组胸骨裂开率为 9.3%，B 组为 1.3%。B 组胸骨裂开明显较低（p<0.05）。
预防性正中胸骨切开术的胸骨编织闭合可降低接受 CABG 的糖尿病肥胖患者胸骨裂开的发病率。
