Kalberer Nina, Frima Herman, Michelitsch Christian, Kloka Jan, Sommer Christoph
Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Department of Anaesthesiology, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Eur J Orthop Surg Traumatol. 2020 Jan;30(1):75-81. doi: 10.1007/s00590-019-02526-z. Epub 2019 Aug 28.
Sternal fractures are rare injuries and mostly treated non-operatively. In selected cases, internal fixation becomes necessary. No standard operative approach has been determined yet among experts. The aim of this study is to describe our treatment algorithm and results after operative stabilisation of sternal fractures with locking compression plates (LCP), mainly focusing on the functional outcome.
A retrospective cohort study was conducted. We included all patients after operative stabilisation of a sternal fracture between 2008 and 2016. Endpoints were the functional outcome using the Activities of Daily Living (ADL) score, pain analysed by the numeric rating scale (NRS), breathing ability, complications and implant removal.
Eighteen out of 153 (12%) patients with a sternal fracture underwent operation. Three patients were lost to follow-up. Eleven out of 15 (73%) patients were treated with double straight LCP 3.5 mm implants and 4 (27%) patients with pre-countered LCP 3.5 mm implants. Mean follow-up was 57 months. The median ADL score was 1 (1-4), the median NRS was 0 (0-9), and respiratory complaints scored a median of 1 (1-4). No non-union, hardware failure or implant-related complication occurred. Post-operative complications were pneumonia (20%) and respiratory insufficiency (20%). Implants were removed in 4/15 (27%) patients; three times due to implant-related irritation, once on patient's request.
Operative stabilisation of sternal fractures with double LCP 3.5 mm provides excellent long-term functional results and seems to be an appropriate option for internal fixation. The rate of post-operative complications is low; however, 27% had a second operation for implant removal.
胸骨骨折是罕见的损伤，多数采用非手术治疗。在某些特定病例中，内固定成为必要手段。目前专家尚未确定标准的手术入路。本研究的目的是描述我们使用锁定加压钢板（LCP）对胸骨骨折进行手术固定后的治疗方案及结果，主要关注功能结局。
进行一项回顾性队列研究。纳入2008年至2016年间所有接受胸骨骨折手术固定的患者。观察终点包括使用日常生活活动（ADL）评分评估的功能结局、通过数字评分量表（NRS）分析的疼痛情况、呼吸能力、并发症及植入物取出情况。
153例胸骨骨折患者中有18例（12%）接受了手术。3例患者失访。15例患者中，11例（73%）接受了双直型3.5毫米LCP植入物治疗，4例（27%）接受了预弯型3.5毫米LCP植入物治疗。平均随访时间为57个月。ADL评分中位数为1（1 - 4），NRS中位数为0（0 - 9），呼吸相关症状评分中位数为1（1 - 4）。未发生骨不连、内固定失败或与植入物相关的并发症。术后并发症为肺炎（20%）和呼吸功能不全（20%）。15例患者中有4例（27%）取出了植入物；3次是由于植入物相关刺激，1次是应患者要求。
使用双3.5毫米LCP对胸骨骨折进行手术固定可提供优异的长期功能结果，似乎是内固定的合适选择。术后并发症发生率较低；然而，27%的患者因取出植入物进行了二次手术。
