Bejko Jonida, Bottio Tomaso, Tarzia Vincenzo, De Franceschi Marco, Bianco Roberto, Gallo Michele, Castoro Massimo, Bortolussi Giacomo, Gerosa Gino
Department of Cardiac Surgery, University of Padua, Medical School of Padua, Italy.
J Cardiovasc Med (Hagerstown). 2015 Feb;16(2):134-8. doi: 10.2459/JCM.0000000000000025.
We sought to assess the efficiency of two different sternal closure techniques in preventing sternal wound instability in high-risk patients.
Between January 2009 and February 2012, 2068 consecutive cardiac patients were prospectively collected in our database. The 561 patients in whom the thermoreactive nitilium clips (Flexigrip) have been used (group A) were matched 1 : 1 with 561 patients who received a standard parasternal wiring technique (group B) on 10 available risk factors known to affect sternal wound healing (age, age >75 years, sex, diabetes mellitus, cardiac procedure, obesity, re-intervention, cross-clamp, and total operative times). The study was completed with a cost analysis.
The two groups were well matched, although different for bilateral internal thoracic harvesting, chronic obstructive pulmonary disease, renal insufficiency, and congestive heart failure, which were significantly more frequent in group A. At 30 days of follow-up, the association of wound complication and sternal instability was significantly less frequent in group A versus group B (0.2 versus 1.6%) (P = 0.04). Overall incidence of sternal wound complication was lower in group A (2 versus 3.5%) (P = 0.28). In the presence of wound infection, a sternal wound instability was never observed in group A (P = 0.06). Overall costs were €8,701,854 and €9,243,702 in groups A and B, respectively; thus the Flexigrip closure technique offered a €541,848 cost saving.
Flexigrip use in high-risk patients showed a lower incidence of sternal wound instability with no need for sternal re-wiring in any case, even in the presence of wound infection.
我们试图评估两种不同的胸骨闭合技术在预防高危患者胸骨伤口不稳定方面的效率。
2009年1月至2012年2月期间，我们前瞻性地收集了2068例连续的心脏病患者的数据。使用热反应性腈夹（Flexigrip）的561例患者（A组）与561例接受标准胸骨旁钢丝固定技术的患者（B组）按照已知影响胸骨伤口愈合的10个风险因素（年龄、年龄>75岁、性别、糖尿病、心脏手术、肥胖、再次干预、交叉夹闭和总手术时间）进行1:1匹配。该研究还进行了成本分析。
两组匹配良好，尽管在双侧胸廓内动脉采集、慢性阻塞性肺疾病、肾功能不全和充血性心力衰竭方面存在差异，这些情况在A组中更为常见。在随访30天时，A组伤口并发症和胸骨不稳定的关联明显低于B组（0.2%对1.6%）（P = 0.04）。A组胸骨伤口并发症的总体发生率较低（2%对3.5%）（P = 0.28）。在伤口感染的情况下，A组从未观察到胸骨伤口不稳定（P = 0.06）。A组和B组的总成本分别为8,701,854欧元和9,243,702欧元；因此，Flexigrip闭合技术节省了541,848欧元的成本。
在高危患者中使用Flexigrip显示胸骨伤口不稳定的发生率较低，在任何情况下都无需重新进行胸骨钢丝固定，即使存在伤口感染。
