Hautalahti Juha, Rinta-Kiikka Irina, Tarkka Matti, Laurikka Jari
Department of Cardiothoracic Surgery, Heart Center Co., Tampere University Hospital, Tampere, Finland.
School of Medicine, University of Tampere, Tampere, Finland.
Thorac Cardiovasc Surg. 2017 Jun;65(4):325-331. doi: 10.1055/s-0035-1549360. Epub 2015 Apr 24.
A cohort of patients having symptoms of sternal nonunion late after sternotomy was studied to find out whether the complaints were related to true sternal nonunion or decreased bone density. A survey was mailed to 2,053 cardiac surgical patients operated in our institution between July 2007 and June 2010. The patients were requested about symptoms referring to sternal instability. A group of symptomatic individuals as well as 1:1 age- and time-matched asymptomatic controls were examined with sternal palpation, ultrasound during standardized sternal pressure provocation, and computed tomography (CT). The number of patients replied in the survey was 1,918 (93.4%); 2.3% (44 patients) reported sensation of movement or clicking in sternum during body movements and during coughing. Symptomatic patients living within 200 km to the hospital (21) and their asymptomatic controls (21) were selected for further clinical and imaging studies. Mean period between the initial operation and the examinations was 36 (22-56) months. Sternal palpation pain was significantly associated with reported symptoms suggestive of sternal nonunion (odds ratio [OR] 22.0; 95% confidence interval [CI] 2.5-195); however, none of the patients had clinically unstable sternum or nonunion in the sternal imaging. The symptoms of sternal instability were more frequent in patients whose bone mineralization rate (as measured with T-scores) was higher. Symptoms suggestive of sternal nonunion were experienced by 2.3%. However, their symptoms did not correlate with CT scans or provocation ultrasound although palpation pain was evident. Thus the pain is derived from nonmechanical etiologies. Higher bone mineralization rate correlated with abnormal symptoms of sternal wound.
对一组胸骨切开术后出现胸骨不愈合晚期症状的患者进行了研究，以确定这些主诉是否与真正的胸骨不愈合或骨密度降低有关。向2007年7月至2010年6月在本机构接受心脏手术的2053例患者邮寄了调查问卷。询问患者有关胸骨不稳定的症状。对一组有症状的个体以及1:1年龄和时间匹配的无症状对照者进行了胸骨触诊、标准化胸骨压力激发时的超声检查以及计算机断层扫描（CT）。调查中回复的患者有1918例（93.4%）；2.3%（44例患者）报告在身体活动和咳嗽时胸骨有移动或喀哒声的感觉。选择居住在距医院200公里以内的有症状患者（21例）及其无症状对照者（21例）进行进一步的临床和影像学研究。初次手术与检查之间的平均时间为36（22 - 56）个月。胸骨触诊疼痛与提示胸骨不愈合的报告症状显著相关（优势比[OR]22.0；95%置信区间[CI]2.5 - 195）；然而，在胸骨影像学检查中，没有患者有临床不稳定的胸骨或不愈合情况。骨矿化率（用T值测量）较高的患者中，胸骨不稳定症状更常见。有2.3%的患者出现提示胸骨不愈合的症状。然而，尽管触诊疼痛明显，但他们的症状与CT扫描或激发超声检查结果无关。因此，疼痛源自非机械性病因。较高的骨矿化率与胸骨伤口的异常症状相关。
