Bayramoglu Zehra, Durak Yasemen, Bayram Muhammed, Ulusoy Onur Levent, Caynak Barıs, Sagbas Ertan, Akpınar Belhan
J Cardiothorac Surg. 2013 Aug 7;8:182. doi: 10.1186/1749-8090-8-182.
Median sternotomy provides excellent access to all mediastinal structures in patients undergoing conventional cardiovascular surgery. Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences. In this regard, considerable effort has been paid to develop techniques aiming to improve sternal healing and to enhance postoperative recovery after conventional cardiac surgery. Among these, kryptonite bone cement, a biocompatible polymer with improved mechanical properties when combined with a standard wire cerclage, represents a promising novel approach that may help prevent sternal dehiscence. In this study, the effects of this particular type of bone cement on sternal healing, postoperative pain, and quality of life have been evaluated.
Kryptonite bone cement enhanced sternal closure was employed in a total of 100 patients undergoing conventional cardiac surgery between November 2009 and June 2012. Of these patients, 50 expressed their willingness to participate in this study. Each participant underwent a computerized tomography imaging for the radiological assessment of sternal healing. Pain and life quality of these patients have been evaluated by Wong-Baker faces pain scale and SF-36 health survey questionnaire, respectively.
Mean duration of follow-up was 20.14 ± 7.36 months (range: 10-32). Mean age and body mass index were 71.32 ± 7.23 years (range: 55-85) and 28.34 ± 2.62 (21-34) kg/m2, respectively. Elderly patients (≥70), females and those with chronic obstructive pulmonary disease (COPD) comprised 64%, 26% and 40% of the study population, respectively. No patients had findings suggestive of dehiscence on CT images. No patients reported severe pain (i.e. all patients had a Wong-Baker faces pain scale score <4). Elderly (≥ 70 yr) subjects had better quality of life scores as compared to the remaining group of patients (< 70 yr) according to SF-36 Health Survey results. Vitality and emotional role scores were lower (63.5 ± 25.5, p = 0.018 and 41.7 ± 23.3, p = 0.001, respectively) in female patients. Patients with COPD had lower quality of life scores than those without COPD, particularly with respect to general health scores (73.3 ± 18.5; p = 0.012).
Kryptonite bone cement, when combined with a standard wire cerclage, enhances mechanical strength, prevents sternal dehiscence, reduces postoperative pain and improves quality of life after conventional cardiac surgery. Long-term studies are warranted to better define the role of kryptonite bone cement in the prevention of sternal dehiscence.
在接受传统心血管手术的患者中，正中胸骨切开术能很好地暴露所有纵隔结构。尽管这种切口技术的并发症发生率相对较低，但某些并发症，如胸骨裂开，可能会带来严重的健康后果。在这方面，人们付出了相当大的努力来开发旨在改善胸骨愈合和提高传统心脏手术后恢复效果的技术。其中，氪石骨水泥是一种生物相容性聚合物，与标准钢丝环扎相结合时具有改善的机械性能，是一种有前景的新方法，可能有助于预防胸骨裂开。在本研究中，评估了这种特殊类型的骨水泥对胸骨愈合、术后疼痛和生活质量的影响。
2009年11月至2012年6月期间，共有100例接受传统心脏手术的患者采用了氪石骨水泥强化胸骨闭合术。其中，50例患者表示愿意参与本研究。每位参与者都接受了计算机断层扫描成像，以进行胸骨愈合的影像学评估。这些患者的疼痛和生活质量分别通过面部表情疼痛量表和SF - 36健康调查问卷进行评估。
平均随访时间为20.14±7.36个月（范围：10 - 32个月）。平均年龄和体重指数分别为71.32±7.23岁（范围：55 - 85岁）和28.34±2.62（21 - 34）kg/m²。老年患者（≥70岁）、女性和慢性阻塞性肺疾病（COPD）患者分别占研究人群的64%、26%和40%。CT图像上没有患者有提示裂开的表现。没有患者报告严重疼痛（即所有患者的面部表情疼痛量表评分<4）。根据SF - 36健康调查结果，老年（≥70岁）受试者的生活质量得分高于其余患者组（<70岁）。女性患者的活力和情感角色得分较低（分别为63.5±25.5，p = 0.018和41.7±23.3，p = 0.001）。COPD患者的生活质量得分低于无COPD的患者，尤其是在总体健康得分方面（73.3±18.5；p = 0.012）。
氪石骨水泥与标准钢丝环扎相结合时，可增强机械强度，预防胸骨裂开，减轻术后疼痛，并改善传统心脏手术后的生活质量。有必要进行长期研究，以更好地确定氪石骨水泥在预防胸骨裂开中的作用。
