使用锁定钢板或网片及钢丝会影响改良拉维奇术后胸骨截骨处出现有症状的骨不连风险吗？

Does the use of locking plates or mesh and wires influence the risk of symptomatic non-union of the sternal osteotomy after modified Ravitch?

作者信息

de Loos Erik R, Hulsewé Karel W E, van Loo Enzo R J, Kragten Johannes A, Höppener Paul F, Busari Jamiu O, Vissers Yvonne L J

机构信息

Department of General and Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.

Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands.

出版信息

J Thorac Dis. 2020 Jul;12(7):3631-3639. doi: 10.21037/jtd-20-527.

DOI:10.21037/jtd-20-527

PMID:32802442

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7399391/

Abstract

BACKGROUND

Patients with pectus excavatum which is unsuitable for minimally invasive repair are usually treated by modified Ravitch procedure. For fixation of the sternal osteotomy, mesh and wires are mostly used. To decrease non-union risk, we introduced a technique with double locking plate fixation of the osteotomy and compared this to fixation using mesh and wires.

METHODS

Patients undergoing a modified Ravitch procedure for pectus excavatum between 2006 and 2016 were included. From 2006 to 2012, the sternum was fixated with mesh and wires. From 2012 to 2016, locking compression plates (LCP) were used. Baseline parameters, symptomatic non-union and total number of complications were retrospectively compared. Statistical analysis was performed using Mann-Whitney or Fisher's exact test. Data are presented as means +/- SD.

RESULTS

Forty-four patients were included. In 18 patients, the sternum was fixed with mesh and wires, in 26 patients with LCP. Mean follow-up was 35 months in the mesh and 30 months in the LCP group, P=0.71. Haller index was similar in both groups (mesh 3.8±1.3 LCP 3.9±1.1, P=0.81). Symptomatic non-union occurred in 17% (n=3) in the mesh group and did not occur after LCP, P=0.062. Total number of complications was 33% (n=6) in the mesh group and 15% (n=4) after LCP, P=0.27.

CONCLUSIONS

After modified Ravitch procedure, union of the sternal osteotomy is challenging. In this retrospective cohort study, a lower incidence of symptomatic non-union was observed after fixation of the sternum with LCPs, with a trend towards statistical significance.

摘要

背景

对于不适合微创修复的漏斗胸患者，通常采用改良Ravitch手术治疗。胸骨截骨固定大多使用网片和钢丝。为降低骨不连风险，我们引入了一种使用双锁定钢板固定截骨的技术，并将其与使用网片和钢丝固定进行比较。

方法

纳入2006年至2016年间接受改良Ravitch手术治疗漏斗胸的患者。2006年至2012年，胸骨用网片和钢丝固定。2012年至2016年，使用锁定加压钢板（LCP）。对基线参数、有症状的骨不连和并发症总数进行回顾性比较。采用Mann-Whitney检验或Fisher精确检验进行统计分析。数据以均值±标准差表示。

结果

共纳入44例患者。18例患者胸骨用网片和钢丝固定，26例患者用LCP固定。网片组平均随访35个月，LCP组平均随访30个月，P = 0.71。两组的Haller指数相似（网片组3.8±1.3，LCP组3.9±1.1，P = 0.81）。网片组有症状的骨不连发生率为17%（n = 3），LCP固定后未发生，P = 0.062。网片组并发症总数为总人数的33%（n = 6），LCP固定后为15%（n = 4），P = 0.27。