正中直线胸骨切开术与交锁胸骨切开术生物力学稳定性的比较。

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability.

作者信息

Küçükdurmaz Fatih, Ağır Ismail, Bezer Murat

机构信息

Fatih Küçükdurmaz, Clinic of Orthopaedics and Traumatology, Bezmialem Vakif University, School of Medicine, Istanbul 34093, Turkey.

出版信息

World J Orthop. 2013 Jul 18;4(3):134-8. doi: 10.5312/wjo.v4.i3.134.

DOI:10.5312/wjo.v4.i3.134

PMID:23878782

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3717247/

Abstract

AIM

To increase the stability of sternotomy and so decrease the complications because of instability.

METHODS

Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in cranio-caudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and cranio-caudal directions were measured and also the opposing bone surface at the osteotomy areas were calculated at the two halves of sternum.

RESULTS

The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1.

CONCLUSION

Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

摘要

目的

提高胸骨切开术的稳定性，从而减少因不稳定导致的并发症。

方法

对20块从肋骨胸骨肋关节分离出的新鲜绵羊胸骨进行测试。分别在10块胸骨上进行正中直线胸骨切开术和交锁胸骨切开术，分别设为第1组和第2组。两种胸骨切开术均使用摆动锯进行，并在三个点用5号直不锈钢丝缝合关闭。通过计算机化材料试验机在每5秒0至400 N（0.2 Hz）的载荷之间循环，在头-尾、前后（AP）和侧向方向进行疲劳测试。测量AP、侧向和头-尾方向的位移量，并计算胸骨两半截骨区域相对的骨表面面积。

结果

正中胸骨切开术在头-尾方向的平均位移为9.66±3.34 mm，交锁胸骨切开术为1.26±0.97 mm，P<0.001。正中胸骨切开术在AP方向的平均位移为9.12±2.74 mm，交锁胸骨切开术为1.20±0.55 mm，P<0.001。正中胸骨切开术在侧向方向的平均位移为8.95±3.86 mm，交锁胸骨切开术为7.24±2.43 mm，P>0.001。正中胸骨切开术的平均表面积为10.40±0.49 cm²，交锁胸骨切开术为16.8±0.78 cm²，P<0.001。第2组在AP和头-尾方向的位移较小，具有统计学意义。第2组在侧向方向的位移较小，但无统计学意义。第2组的表面积明显大于第1组。