在胸骨深部伤口感染的外科治疗中，胸骨重新固定是必需的吗？
Is sternal rewiring mandatory in surgical treatment of deep sternal wound infections?
作者信息
Rashed Aref, Gombocz Karoly, Alotti Nasri, Verzar Zsofia
机构信息
Department of Cardiac Surgery, St. Rafael Zala County Hospital, Zalaegerszeg, Hungary.
Department of Emergency Medicine, Pecs University of Science, Pecs, Hungary.
出版信息
J Thorac Dis. 2018 Apr;10(4):2412-2419. doi: 10.21037/jtd.2018.03.166.
BACKGROUND
Deep sternal wound infections (DSWIs) are a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. We compared treatment outcomes after conventional sternal rewiring and reconstruction with no sternal rewiring in patients with a sternal wound infection.
METHODS
We retrospectively enrolled patients who developed a DSWI after an open-heart procedure with median sternotomy at the Department of Cardiac Surgery, at the St. Rafael Hospital, Zalaegerszeg, Hungary, between 2012 and 2016. All patients received negative pressure wound and antibiotic therapy before surgical reconstruction. Patients were divided into groups determined by the reconstruction technique and compared. Subjects were followed up for 12 months, and the primary end-points were readmission and 90-day mortality.
RESULTS
Among 3,177 median sternotomy cases, 60 patients developed a DSWI, 4 of whom died of sepsis before surgical treatment. Fifty-six patients underwent surgical reconstruction with conventional sternal rewiring (23 cases, 41%) or another interventions with no sternal refixation (33 cases, 59%). Eighty-one percent of sternal wound infections followed coronary bypass surgery (alone or combinated with another procedures), and 60% were diagnosed after hospital discharge. was cultured in 30% of all wounds and, 56.5% of cases reconstructed by sternal rewiring 26.5% with no sternal rewiring, (P=0.022). Hospital readmission occurred in 63.6% of the sternal rewiring group 14.7% of the no sternal rewiring group. The rate of death before wound healing or the 90 postoperative day was 21.7% in the sternal rewiring group 0% in the no sternal rewiring group. The median hospital stay was longer in the sternal rewiring group than in the other group (51 30 days, P=0.006).
CONCLUSIONS
Sternal rewiring may be associated with a higher rate of treatment failure than other forms of treatment for sternal wound infections.
背景
深部胸骨伤口感染（DSWI）是正中开胸术后一种罕见但严重的并发症，治疗成功主要取决于手术经验。我们比较了胸骨伤口感染患者采用传统胸骨重新固定和重建与不进行胸骨重新固定的治疗效果。
方法
我们回顾性纳入了2012年至2016年期间在匈牙利扎拉埃格塞格圣拉斐尔医院心脏外科接受正中开胸心脏手术术后发生DSWI的患者。所有患者在手术重建前均接受负压伤口治疗和抗生素治疗。根据重建技术将患者分组并进行比较。对受试者进行12个月的随访，主要终点为再次入院和90天死亡率。
结果
在3177例正中开胸病例中，60例发生DSWI，其中4例在手术治疗前死于败血症。56例患者接受了传统胸骨重新固定的手术重建（23例，41%）或其他未进行胸骨重新固定的干预措施（33例，59%）。81%的胸骨伤口感染发生在冠状动脉搭桥手术后（单独或与其他手术联合），60%在出院后被诊断。所有伤口中有30%培养出[具体细菌名称未给出]，胸骨重新固定重建的病例中有56.5%培养出该菌，未进行胸骨重新固定的病例中有26.5%培养出该菌（P = 0.022）。胸骨重新固定组的再次入院率为63.6%，未进行胸骨重新固定组为14.7%。伤口愈合前或术后90天内的死亡率在胸骨重新固定组为21.7%，未进行胸骨重新固定组为0%。胸骨重新固定组的中位住院时间比另一组更长（51对30天，P = 0.006）。
结论
与胸骨伤口感染的其他治疗方式相比，胸骨重新固定可能与更高的治疗失败率相关。
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