Liao Joshua M, Chan Patrick, Cornwell Lorraine, Tsai Peter I, Joo Joseph H, Bakaeen Faisal G, Luketich James D, Chu Danny
Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Cardiothorac Surg. 2019 Jan 28;14(1):25. doi: 10.1186/s13019-019-0841-y.
Morbidly obese patients (body mass index [BMI] ≥ 35 kg/m) who undergo cardiac surgery involving median sternotomy have a higher-than-normal risk of sternal dehiscence. To explore a potential solution to this problem, we examined the utility of transverse sternal plating for primary sternal closure in morbidly obese cardiac surgical patients.
We retrospectively reviewed data from cardiac surgical patients who underwent single primary xiphoid transverse titanium plate reinforcement for primary sternal closure from August 2009 to July 2010 (n = 8), and we compared their outcomes with those of patients with BMI ≥35 kg/m who underwent cardiac surgery without sternal plate reinforcement from April 2008 to July 2009 (n = 14). All cases were performed by the same surgeon.
The 2 groups of patients had similar demographics and comorbidities (P > 0.05 for all). All patients with sternal plate reinforcement reported sternal stability at last follow-up (at a median of 27 months postoperatively; range, 8.4-49.3 months), whereas 1 patient (7.1%) who underwent standard closure developed sterile sternal dehiscence (P = 0.4). Postoperative patient-controlled analgesia (PCA) morphine usage was significantly higher for patients without sternal plate reinforcement than for patients who had sternal plate reinforcement (3.6 mg/h vs 1.3 mg/h, P = 0.008). No patient in the sternal plate group had wound seroma or perioperative complications attributable to sternal closure technique.
Single xiphoid transverse plate reinforcement for primary sternal closure is a feasible option for morbidly obese patients, who are otherwise at high risk of developing sternal dehiscence. Using this technique may decrease postoperative narcotics usage. Morbidly obese patients (body mass index ≥35 kg/m) have a higher-than-normal risk of sternal dehiscence after cardiac surgery. In a pilot study, we found that those who underwent transverse sternal plating (n = 8) had no sternal dehiscence and required less postoperative analgesia than patients who underwent standard wire closure (n = 14).
接受正中开胸心脏手术的病态肥胖患者（体重指数[BMI]≥35kg/m²）发生胸骨裂开的风险高于正常水平。为探索该问题的潜在解决方案，我们研究了横向胸骨钢板固定术在病态肥胖心脏手术患者一期胸骨闭合中的应用价值。
我们回顾性分析了2009年8月至2010年7月期间接受单根剑突下横向钛板加强一期胸骨闭合的心脏手术患者的数据（n = 8），并将其结果与2008年4月至2009年7月期间BMI≥35kg/m²且未行胸骨钢板加强的心脏手术患者（n = 14）的结果进行比较。所有病例均由同一位外科医生实施。
两组患者的人口统计学特征和合并症相似（所有P>0.05）。所有接受胸骨钢板加强的患者在最后一次随访时（术后中位时间27个月；范围8.4 - 49.3个月）均报告胸骨稳定，而1例接受标准闭合术的患者（7.1%）发生了无菌性胸骨裂开（P = 0.4）。未行胸骨钢板加强的患者术后自控镇痛（PCA）吗啡用量显著高于行胸骨钢板加强的患者（3.6mg/h对1.3mg/h，P = 0.008）。胸骨钢板组没有患者出现伤口血清肿或因胸骨闭合技术导致的围手术期并发症。
对于病态肥胖患者，单根剑突下横向钢板加强一期胸骨闭合是一种可行的选择，否则这些患者发生胸骨裂开的风险很高。使用该技术可能会减少术后麻醉药物的使用。病态肥胖患者（体重指数≥35kg/m²）心脏手术后发生胸骨裂开的风险高于正常水平。在一项初步研究中，我们发现接受横向胸骨钢板固定术的患者（n = 8）未发生胸骨裂开，且术后镇痛需求低于接受标准钢丝闭合术的患者（n = 14）。
