Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Thorac Cardiovasc Surg. 2013 Oct;146(4):901-5. doi: 10.1016/j.jtcvs.2013.04.033. Epub 2013 Jun 12.
Bilateral transverse thoracosternotomy (clamshell incision) is a widely used approach in bilateral sequential lung transplantation, but the closure technique is associated with sternal dehiscence. This study compares the incidence of sternal dehiscence between the crossed and uncrossed closure techniques.
In 129 patients who underwent transplantation through a clamshell incision, the sternum was closed using either the crossed or the uncrossed method based on the surgeon's preference. The position of the sternal parts was evaluated on lateral chest radiographs and scored as normal, override, or separation.
We observed sternal override in 38 patients and separations in 18 patients. The sternum was closed using the uncrossed method in 79 patients and the crossed method in 50 patients. There were significantly fewer overrides (n = 6, 12.0%) and separations (n = 6, 12.0%) of the sternal parts using the crossed closure technique compared with the uncrossed technique (32 overrides, 41.0%; and 12 separations, 15.1%; P < .001). Reconstructive surgery was only performed in patients with separation of the sternal parts (n = 10).
Using the crossed closure technique for the sternum after bilateral sequential lung transplantation reduces the incidence of sternal dehiscence compared with the uncrossed closure technique and, therefore, reduces the necessity of reconstructive surgery.
双侧经胸骨正中切开术（蛤壳式切口）是双侧序贯肺移植中广泛应用的方法，但关闭技术与胸骨裂开有关。本研究比较了交叉与非交叉关闭技术后胸骨裂开的发生率。
在 129 例通过蛤壳式切口进行移植的患者中，根据外科医生的偏好，使用交叉或非交叉方法关闭胸骨。通过侧位胸部 X 线片评估胸骨部分的位置，并将其评分正常、重叠或分离。
我们观察到 38 例胸骨重叠和 18 例胸骨分离。79 例患者采用非交叉方法关闭胸骨，50 例患者采用交叉方法。与非交叉技术相比，交叉技术胸骨部分重叠（n=6，12.0%）和分离（n=6，12.0%）明显减少（32 例重叠，41.0%；12 例分离，15.1%；P<.001）。仅对胸骨部分分离的患者（n=10）进行了重建手术。
双侧序贯肺移植后使用交叉胸骨闭合技术可降低胸骨裂开的发生率，与非交叉闭合技术相比，减少了重建手术的必要性。
