Kukulski Leszek, Krawczyk Aleksandra, Pacholewicz Jerzy
Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Poland.
Kardiochir Torakochirurgia Pol. 2018 Dec;15(4):233-237. doi: 10.5114/kitp.2018.80919. Epub 2018 Dec 31.
Sternum closure techniques have been compared regarding biomechanics, efficacy in high-risk patients and prevention of mediastinitis or sternal dehiscence. There are no papers concerning patients' comfort and postoperative rehabilitation rate.
To establish the best surgical closure technique after midline sternotomy regarding the lowest pain level in the postoperative period and the highest rate of postoperative rehabilitation.
A retrospective analysis was performed on a group of 100 patients after cardiothoracic procedures which was divided into 3 subgroups according to sternal closure technique based on postoperative thoracic X-ray. To assess patients' pain and their physical activity we used a custom questionnaire. The statistical analysis was performed on the data regarding occurrence of wound healing complications risk factors, Numerical Rating Scale (NRS) for Pain score, the number of days until achieving important rehabilitations stages and the occurrence of sternal refixation.
Subgroups had 35, 33 and 32 patients. The statistical analysis showed significantly lower NRS scores between the 14 ( = 0.0012) (1.17) and 30 ( = 0.0196) day (0.65) after the procedure in the group sutured with only single interrupted wire. There was also a significant difference in the number of days between the operation and the first time the patient could lie sideways ( = 0.0105). There was no statistically significant difference between the three groups regarding other measured factors.
The single wire suture provides less pain at the 14 and 30 day postoperatively measured on the NRS and ensures faster rehabilitation compared to sternal closing technique which involves placing both single and figure-of-8 sutures.
已对胸骨闭合技术在生物力学、高危患者中的疗效以及纵隔炎或胸骨裂开的预防方面进行了比较。尚无关于患者舒适度和术后康复率的相关论文。
确定正中开胸术后最佳的手术闭合技术，以实现术后最低疼痛水平和最高术后康复率。
对一组100例心胸外科手术后的患者进行回顾性分析，根据术后胸部X线的胸骨闭合技术将其分为3个亚组。我们使用定制问卷评估患者的疼痛情况及其身体活动。对有关伤口愈合并发症危险因素的发生情况、疼痛评分的数字评定量表（NRS）、达到重要康复阶段所需的天数以及胸骨重新固定的发生情况的数据进行统计分析。
各亚组分别有35例、33例和32例患者。统计分析显示，在仅用单根间断缝线缝合的组中，术后第14天（P = 0.0012）（1.17）和第30天（P = 0.0196）（0.65）的NRS评分显著更低。手术至患者首次能侧卧的天数之间也存在显著差异（P = 0.0105）。在其他测量因素方面，三组之间无统计学显著差异。
与采用单根缝线和8字缝线相结合的胸骨闭合技术相比，单根缝线缝合在术后第14天和第30天经NRS测量的疼痛较轻，并能确保更快康复。
