Kamiya Hiroyuki, Al-maisary Sameer S A, Akhyari Payam, Ruhparwar Arjang, Kallenbach Klaus, Lichtenberg Artur, Karck Matthias
Department of Cardiovascular Surgery, University of Düsseldorf, Düsseldorf, Germany.
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):665-70. doi: 10.1093/icvts/ivs293. Epub 2012 Jul 6.
Sternal dehiscence and mediastinitis are rare but serious complications following cardiac surgery. The aim of this study was to investigate the influence of the number of sternal wires used for chest closure on sternal complications.
From May 2003 to April 2007, 4714 adult patients received cardiac surgery in our institute. X-ray images of all patients were reviewed and the used wires were counted. Patients who received another material or longitudinal wiring technique according to Robicsek for chest closure were excluded from this analysis; thus 4466 patients were included into the final analysis. Figure-of-eight wiring was counted as two wires.
Sternal complications occurred in 2.4%, and hospital mortality with or without sternal complications were 2.8 and 2.7%, respectively (P = 0.60). Mean numbers of sternal wires were 7.8 in both patient groups with or without sternal complications (P = 0.79). Multivariate analysis revealed diabetes mellitus [odds ratio (OR) 1.54, 95% CI 1.01-2.34, P = 0.04], chronic obstructive pulmonary disease (OR 1.85, 95% CI 1.12-2.79, P = 0.01) and renal insufficiency (OR 1.70, 95% CI 1.11-2.59, P = 0.001) as significant risk factors for sternal complications. In high-risk patients, the use of less than eight wires was significantly associated with postoperative sternal complications.
Particularly in high-risk patients, careful haemostasis should be done and eight or more wires should be used to avoid sternal complications.
胸骨裂开和纵隔炎是心脏手术后罕见但严重的并发症。本研究旨在探讨用于关闭胸腔的胸骨钢丝数量对胸骨并发症的影响。
2003年5月至2007年4月，我院4714例成年患者接受了心脏手术。回顾了所有患者的X线图像并对使用的钢丝进行计数。根据Robicsek方法使用其他材料或纵向钢丝技术进行胸腔关闭的患者被排除在本分析之外；因此，4466例患者被纳入最终分析。8字形钢丝计数为两根钢丝。
胸骨并发症发生率为2.4%，有或无胸骨并发症的患者医院死亡率分别为2.8%和2.7%（P = 0.60）。有或无胸骨并发症的患者组胸骨钢丝平均数量均为7.8根（P = 0.79）。多变量分析显示，糖尿病[比值比（OR）1.54，95%可信区间1.01 - 2.34，P = 0.04]、慢性阻塞性肺疾病（OR 1.85，95%可信区间1.12 - 2.79，P = 0.01）和肾功能不全（OR 1.70，95%可信区间1.11 - 2.59，P = 0.001）是胸骨并发症的显著危险因素。在高危患者中，使用少于八根钢丝与术后胸骨并发症显著相关。
特别是在高危患者中，应仔细止血并使用八根或更多钢丝以避免胸骨并发症。
