Matsuyama Katsuhiko, Kuinose Masahiko, Koizumi Nobusato, Iwasaki Tomoaki, Toguchi Kayo, Ogino Hitoshi
Department of Cardiovascular Surgery, Tokyo Medical University Hospital, 6-7-1 Nishshinjuku Shinjyuku-ku, Tokyo, 160-0023, Japan.
J Artif Organs. 2016 Jun;19(2):175-8. doi: 10.1007/s10047-015-0870-9. Epub 2015 Oct 13.
Sternal instability or dehiscence results in serious sternal wound infection. We sought to assess the early outcomes with such a plating system for sternal closure in comparison to the conventional wiring technique in off-pump coronary artery bypass grafting (CABG). Patients who underwent off-pump CABG were enrolled. Thirty-one patients received plate sternal fixation. A total of 64 patients who underwent off-pump CABG by a single surgeon at our hospital from July 2013 to December 2014 were enrolled. Thirty-one patients received plate sternal fixation (Plate group), while 33 received conventional wire closure (Wire group). The early outcomes, including the pain score and analgesic usage count were compared. Dietary intake was also recorded to assess the duration of appetite loss. At discharge, the largest sternal displacement was measured on computed tomography. In the Plate group, the pain scores were significantly lower on post-operative day 5-8 and POD 9-12 from those in the Wire group. The analgesic usage count on POD 9-12 was significantly lower in the Plate group. The duration of appetite loss and hospital stay was significantly shorter in the Plate group. The displacement in both the anterior-posterior and lateral directions was significantly smaller in the Plate group. Sternal closure by rigid plate fixation contributes to a more rapid post-operative recovery through reduced pain.
胸骨不稳定或裂开可导致严重的胸骨伤口感染。我们试图评估在非体外循环冠状动脉旁路移植术（CABG）中，与传统钢丝固定技术相比，使用这种钢板固定系统进行胸骨闭合的早期效果。纳入接受非体外循环CABG的患者。31例患者接受钢板胸骨固定。2013年7月至2014年12月期间，我院共有64例由同一位外科医生进行非体外循环CABG的患者纳入研究。31例患者接受钢板胸骨固定（钢板组），33例接受传统钢丝闭合（钢丝组）。比较早期效果，包括疼痛评分和镇痛药使用次数。还记录饮食摄入量以评估食欲丧失的持续时间。出院时，通过计算机断层扫描测量最大胸骨移位。在钢板组中，术后第5 - 8天和第9 - 12天的疼痛评分明显低于钢丝组。钢板组术后第9 - 12天的镇痛药使用次数明显更低。钢板组食欲丧失的持续时间和住院时间明显更短。钢板组在前后方向和侧向的移位明显更小。通过刚性钢板固定进行胸骨闭合，可通过减轻疼痛促进术后更快恢复。
