Melly Ludovic, Gahl Brigitta, Meinke Ruth, Rueter Florian, Matt Peter, Reuthebuch Oliver, Eckstein Friedrich S, Grapow Martin T R
Clinic for Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):219-23; discussion 223-4. doi: 10.1093/icvts/ivt183. Epub 2013 Apr 26.
To determine the difference in sternal infection and other infectious events between conventional wire and cable-tie-based closure techniques post-sternotomy in a collective of patients after cardiac surgery.
The sternal ZipFix™ (ZF) system consists of a biocompatible poly-ether-ether-ketone (PEEK) cable-tie that surrounds the sternum through the intercostal space and provides a large implant-to-bone contact. Between 1 February 2011 and 31 January 2012, 680 cardiac operations were performed via sternotomy at our institution. After the exclusion of operations for active endocarditis and early mortality within 7 days, 95 patients were exclusively closed with ZF and could be compared with 498 who were closed with conventional wires (CWs) during the same period. A multivariable logistic regression analysis, including body mass index, renal impairment and emergency as suspected confounders and inverse propensity weights was performed on the infection rate.
Total infection rate was 6.1%, with a total of 36 diagnosed sternal infections (5 in ZF and 31 in CW). Comparing ZF with CW with regard to sternal infection, there is no statistically significant difference related to the device (odds ratio: 0.067, confidence interval: 0.04-9.16, P=0.72). The propensity modelling provided excellent overlap and the mean propensity was almost the same in both groups. Thus, we have observed no difference in receiving either ZF or CW. No sternal instability was observed with the ZF device, unlike 4/31 patients in the CW group. The overall operation time is reduced by 11 min in the ZF group with identical perfusion and clamping times.
Our study underlines a neutral effect of the sternal ZipFix™ system in patients regarding sternal infection. Postoperative complications are similar in both sternal closure methods. The cable-tie-based system is fast, easy to use, reliable and safe.
确定心脏手术后患者群体中，传统钢丝和基于束带的胸骨闭合技术在胸骨感染及其他感染事件方面的差异。
胸骨ZipFix™（ZF）系统由一种生物相容性聚醚醚酮（PEEK）束带组成，该束带通过肋间间隙环绕胸骨，提供大面积的植入物与骨接触。2011年2月1日至2012年1月31日期间，我院通过胸骨切开术进行了680例心脏手术。排除活动性心内膜炎手术和7天内的早期死亡病例后，95例患者仅采用ZF进行闭合，并可与同期采用传统钢丝（CW）闭合的498例患者进行比较。对感染率进行多变量逻辑回归分析，包括体重指数、肾功能损害和急诊情况作为疑似混杂因素以及逆倾向权重。
总感染率为6.1%，共诊断出36例胸骨感染（ZF组5例，CW组31例）。比较ZF和CW在胸骨感染方面的情况，与器械相关无统计学显著差异（比值比：0.067，置信区间：0.04 - 9.16，P = 0.72）。倾向模型显示两组有良好的重叠，平均倾向几乎相同。因此，我们观察到接受ZF或CW没有差异。与CW组31例患者中的4例不同，ZF装置未观察到胸骨不稳定情况。ZF组在灌注和夹闭时间相同的情况下，总手术时间减少了11分钟。
我们的研究强调了胸骨ZipFix™系统在患者胸骨感染方面的中性作用。两种胸骨闭合方法的术后并发症相似。基于束带的系统快速、易用、可靠且安全。
