De Palma Angela, Sollitto Francesco, Loizzi Domenico, Di Gennaro Francesco, Scarascia Daniele, Carlucci Annalisa, Giudice Giuseppe, Armenio Andrea, Ludovico Rossana, Loizzi Michele
1 Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy ; 2 Section of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy ; 3 Section of Plastic Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.
J Thorac Dis. 2016 Mar;8(3):490-8. doi: 10.21037/jtd.2016.02.64.
We report short and long-term results with the dedicated Synthes(®) titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction.
We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16-83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire].
Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115-430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5-129 days). At a median follow-up of 20 months (range: 1-59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life.
An optimal chest wall stabilization and reconstruction was achieved with the Synthes(®) titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time and post-operative hospital stay. Long-term restoration of a normal respiratory function was achieved, with minimal plates-related morbidity and chest pain.
我们报告了5年前推出的专用Synthes（®）钛板系统用于胸壁稳定和重建的短期和长期结果。
我们回顾性分析了（2010年1月至2014年12月）连续27例患者（22例男性，5例女性；年龄范围16 - 83岁，中位年龄60岁），采用该系统治疗：原发性[3例]和继发性[8例]胸壁肿瘤；连枷胸[5例]；多根肋骨骨折[5例]；胸骨裂开 - 分离[3例]；胸骨骨折[1例]；胸锁关节脱位[1例]；波兰综合征[1例]。短期结果评估指标为：手术时间、术后发病率、死亡率、住院时间；长期结果评估指标为：生存率、与钛板相关的发病率、肺功能测定值、胸痛[采用视觉模拟评分法（VRS）和SF12标准V1问卷进行测量]。
每位患者接受1至10块（中位值2块）钛板/夹板；中位手术时间为150分钟（范围：115 - 430分钟）。术后病程：15例患者（55.6%）顺利，10例（37%）出现轻微并发症，2例（7.4%）出现严重并发症；无术后死亡病例。术后中位住院时间为13天（范围：5 - 129天）。中位随访20个月（范围：1 - 59个月）时，21例患者（78%）存活，6例（22%）死亡。3例患者出现与钛板相关的长期并发症：钛板断裂[2例]、针板移位[1例]；2例需要再次手术探查。术后1年的中位肺功能测定值为：用力肺活量（FVC）3.31升（90%），1秒用力呼气容积（FEV1）2.46升（78%），一氧化碳弥散量（DLCO）20.9毫升/毫米汞柱/分钟（76%）。在21例存活患者中，7例（33.3%）报告无疼痛（VRS评分0），10例（47.6%）为轻度疼痛（评分2），4例（19.1%）为中度疼痛（评分4），无重度疼痛（评分>4）患者；15例（71.5%）报告无疼痛或轻度疼痛，6例（28.5%）为中度疼痛影响生活质量。
Synthes（®）钛板系统实现了最佳的胸壁稳定和重建，发病率极低，无术后死亡病例，手术时间和术后住院时间可接受。实现了正常呼吸功能的长期恢复，与钛板相关的发病率和胸痛极低。
