Fu Xian-ming, Oshima Hideki, Araki Yoshimori, Narita Yuji, Mutsuga Masato, Okada Noritaka, Tsunekawa Tomohiro, Usui Akihiko
Department of Cardiothoracic Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan,
J Artif Organs. 2013 Dec;16(4):458-63. doi: 10.1007/s10047-013-0727-z. Epub 2013 Aug 31.
Bioabsorbable poly-L-lactide (PLLA) sternal pins are applied to reinforce sternal closure during cardiac surgery. However, these pins lack osteoconductivity. A new bioabsorbable sternal pin with osteoconductivity, made of uncalcined hydroxyapatite and poly-L-lactide (u-HA-PLLA) has been developed. This study was conducted to compare the two types of sternal pins in terms of sternal stability and healing after median sternotomy. Between October 2006 and January 2012, 105 patients underwent aortic surgery for aortic aneurysms or dissection via median sternotomy and sternal closure with sternal pins. Among these patients, 75 were followed for 12 months using serial computed tomography (CT). PLLA sternal pins were used in 30 patients (group A) and u-HA-PLLA sternal pins were used in 45 patients (group B). The incidence rates of transverse sternal dehiscence, anteroposterior displacement and complete sternal fusion were evaluated using CT. The cross-sectional cortical bone density area (CBDA) of the sternum around the sternal pins was examined to evaluate the osteoconductivity of the sternal pins. There were no significant differences between groups A and B in the sternal dehiscence rate (6.7 vs 4.4 %), sternal displacement rate (6.7 vs 2.2 %) or 12-month sternal fusion rate (63.3 vs 73.3 %). The CBDA around the sternal pins significantly increased between discharge and 12 months after surgery in group B (P < 0.001) but not in group A. These results show that u-HA-PLLA sternal pins exhibit certain osteoconductivity; however, both PLLA and u-HA-PLLA sternal pins provide comparable clinical outcomes regarding sternal stability and healing.
生物可吸收聚左旋乳酸（PLLA）胸骨钉用于心脏手术中加强胸骨闭合。然而，这些钉子缺乏骨传导性。一种由未煅烧羟基磷灰石和聚左旋乳酸（u-HA-PLLA）制成的具有骨传导性的新型生物可吸收胸骨钉已被研发出来。本研究旨在比较这两种类型的胸骨钉在正中开胸术后胸骨稳定性和愈合方面的差异。2006年10月至2012年1月期间，105例患者通过正中开胸和使用胸骨钉进行胸骨闭合术接受了主动脉瘤或主动脉夹层的主动脉手术。在这些患者中，75例使用系列计算机断层扫描（CT）进行了12个月的随访。30例患者使用PLLA胸骨钉（A组），45例患者使用u-HA-PLLA胸骨钉（B组）。使用CT评估横向胸骨裂开、前后移位和完全胸骨融合的发生率。检查胸骨钉周围胸骨的横截面皮质骨密度面积（CBDA）以评估胸骨钉的骨传导性。A组和B组在胸骨裂开率（6.7%对4.4%）、胸骨移位率（6.7%对2.2%）或12个月胸骨融合率（63.3%对73.3%）方面无显著差异。B组胸骨钉周围的CBDA在出院至术后12个月之间显著增加（P<0.001），而A组未增加。这些结果表明，u-HA-PLLA胸骨钉具有一定的骨传导性；然而，PLLA和u-HA-PLLA胸骨钉在胸骨稳定性和愈合方面提供了相当的临床结果。
