Department of Cardiac Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China.
Contrast Media Mol Imaging. 2022 May 29;2022:8622498. doi: 10.1155/2022/8622498. eCollection 2022.
Median sternotomy is the most applied approach in open-heart surgery, while potential complications such as postoperative bleeding, sternal dehiscence, and deep sternal wound infection (DWSI) still remain a challenge to cardiac surgeons. Several new sternum-closure products instead of stainless wire have been brought into clinical application. The objective of this retrospective study is to evaluate the novel sternum-fixing product in terms of clinical outcomes.
689 consecutive cases undergoing cardiac surgery through median sternotomy between February 2015 and December 2018 in our center were enrolled in this study. All the cases were divided into two groups according to different sternum fixation methods: wire cerclage group and rigid fixator group. The demographic as well as clinical data including the mediastinal drainage of first, second, and third post-op 24 hours, the total mediastinal drainage of post-op 72 hours, ICU duration, length of hospital stay, and post-op mortality in 30 days were collected and compared between the two groups.
278 cases were enrolled in the wire cerclage group and 411 cases in the rigid fixator group. There is no significant difference in the demographic data between the two groups, while the mediastinal drainage in the first and third 24 hours after surgery and the total mediastinal drainage in postoperative 72 hours of the rigid fixator group were significantly less than those of the wire cerclage group ( < 0.05). No significant difference was found in other clinical outcomes between the groups including ICU duration, LOS in hospital, and 30-day mortality. 14 cases (5.0%) in the wire cerclage group and 11 cases (2.7%) in the rigid fixator group had sternotomy-related complications including severe postoperative bleeding, sternal dehiscence, and DSWI.
Compared with the conventional wire cerclage, the new rigid fixator is superior in median sternotomy closure in terms of postoperative mediastinal bleeding as well as incidence of sternotomy-related complications.
正中开胸术是心脏直视手术中最常用的方法，但术后出血、胸骨裂开和深部胸骨伤口感染（DWSI）等潜在并发症仍然是心脏外科医生面临的挑战。一些新的胸骨闭合产品已经取代了不锈钢丝，应用于临床。本回顾性研究旨在评估新型胸骨固定产品的临床效果。
本研究纳入了 2015 年 2 月至 2018 年 12 月期间在我院行正中开胸心脏手术的 689 例连续病例。所有病例均根据不同的胸骨固定方法分为两组：钢丝环扎组和刚性固定器组。收集并比较两组病例的人口统计学及临床资料，包括术后第 1、2、3 天 24 小时的纵隔引流量、术后 72 小时的纵隔总引流量、重症监护病房（ICU）时间、住院时间和术后 30 天死亡率。
钢丝环扎组 278 例，刚性固定器组 411 例。两组病例的人口统计学数据无显著差异，而刚性固定器组术后第 1 和第 3 天 24 小时及术后 72 小时纵隔引流量均明显少于钢丝环扎组（<0.05）。两组其他临床结果如 ICU 时间、住院时间和 30 天死亡率无显著差异。钢丝环扎组 14 例（5.0%）和刚性固定器组 11 例（2.7%）发生胸骨切开相关并发症，包括严重术后出血、胸骨裂开和 DSWI。
与传统的钢丝环扎相比，新型刚性固定器在正中开胸术胸骨闭合方面具有术后纵隔出血少、胸骨切开相关并发症发生率低的优点。
