Wang Wei, Wang Shaohua
Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
J Cardiothorac Surg. 2016 Apr 8;11:46. doi: 10.1186/s13019-016-0458-3.
Deep sternal wound infection (DSWI) is a serious complication post cardiac surgery and associated with increased mortality, morbidity and cost. Sternal titanium plate fixation could be an effective approach to treat DSWI. We sought to compare the effectiveness of titanium plate fixation with conventional approach in the treatment of DSWI.
Retrospective data was analyzed from consecutive patients with DSWI post cardiac surgery who received either titanium plate fixation (sternal plate group) or conventional treatment with sternal debridement and rewiring (control group). Pre-operative risk factors and post-operative clinical outcome were compared between the 2 groups.
A total of 36 patients (mean age 65.0 ± 8.6, 63.9 % male) with DSWI were in the sternal plate group whereas 26 patients (mean age 64.0 ± 13.4, 65.4 % male) were in the control group. The mean follow-up period was 15.92 months. The major pre-operative comorbidities were comparable between the 2 groups. The rate of receiving multiple debridement procedures (≥ 3) was significantly lower in the sternal plate group (5.6 % vs. 26.9 %, P = 0.03). Patients in the sternal plate group had no treatment failure, whereas 42.3 % of patients in the control group had treatment failure requiring muscle flaps reconstruction by plastic surgery (0 % vs. 42.3 %, P < 0.001). There was a trend of lower in-hospital mortality (11.1 % vs. 19.2 %, P = 0.47) in the sternal plate group.
Compared to conventional treatment, titanium plate fixation appears to have favorable clinical outcome.
深部胸骨伤口感染（DSWI）是心脏手术后的一种严重并发症，与死亡率、发病率增加及成本上升相关。胸骨钛板固定可能是治疗DSWI的一种有效方法。我们试图比较钛板固定与传统方法治疗DSWI的有效性。
对心脏手术后发生DSWI并接受钛板固定（胸骨板组）或胸骨清创和重新缝合的传统治疗（对照组）的连续患者的回顾性数据进行分析。比较两组术前危险因素和术后临床结果。
胸骨板组共有36例DSWI患者（平均年龄65.0±8.6岁，男性占63.9%），而对照组有26例患者（平均年龄64.0±13.4岁，男性占65.4%）。平均随访期为15.92个月。两组术前主要合并症相当。胸骨板组接受多次清创手术（≥3次）的比例显著较低（5.6%对26.9%，P = 0.03）。胸骨板组患者无治疗失败，而对照组42.3%的患者治疗失败，需要整形外科进行肌皮瓣重建（0%对42.3%，P < 0.001）。胸骨板组院内死亡率有降低趋势（11.1%对19.2%，P = 0.47）。
与传统治疗相比，钛板固定似乎具有良好的临床效果。
