Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Heart Surg Forum. 2022 Jul 12;25(4):E494-E499. doi: 10.1532/hsf.4843.
To explore the personalized treatment strategy of sternal fixation and closure of sternal median incision in open cardiac surgery.
A total of 293 patients who underwent open-heart surgery with a median sternal incision at Peking Union Medical College Hospital from January 2019 to March 2021 were divided into two groups, according to the timing and type of treatment. The first 169 patients received single-wire fixation and closure (control group), while the subsequent 124 patients received double-wire fixation and closure (study group). The patients were followed up for three months to observe the duration of pain, sternal instability, and occurrence of chest wound infection.
The average age was 53±30 years in the control group and 55±34 years in the study group (P = 0.594). There were no significant differences in baseline data between the two groups (P > 0.05). Compared with the control group, the study group had a shorter duration of pain (P < 0.05), smaller drainage volume within three days postoperatively (650 ml vs. 770 ml, P < 0.05), lower incidence of superficial sternal wound infection (2.4% vs. 8.9%, P = 0.042), and lower incidence of sternal instability (1.6% vs. 8.3%, P = 0.026). Deep sternal wound infection occurred in two patients in the control group and none in the study group; however, this difference was not significant. No surgery-related deaths occurred.
Selecting the appropriate sternal fixation and closure method, according to the characteristics of patients, can reduce the incidence of sternal incision complications. We proposed a personalized selection strategy for sternal fixation and closure, which requires verification in clinical studies.
探讨心脏直视手术胸骨正中切口胸骨固定与关闭的个体化治疗策略。
选择 2019 年 1 月至 2021 年 3 月在我院行正中开胸心脏手术的 293 例患者，根据治疗时机和方法分为两组。前 169 例采用单钢丝固定（对照组），后 124 例采用双钢丝固定（研究组）。术后 3 个月内随访疼痛持续时间、胸骨稳定性及胸壁感染发生情况。
对照组平均年龄为 53±30 岁，研究组为 55±34 岁（P=0.594）。两组患者一般资料比较差异无统计学意义（P＞0.05）。与对照组比较，研究组疼痛持续时间较短（P＜0.05），术后 3 天内引流量较少（650 ml 比 770 ml，P＜0.05），胸骨切口感柒发生率较低（2.4%比 8.9%，P=0.042），胸骨不稳定发生率较低（1.6%比 8.3%，P=0.026）。对照组 2 例发生深部胸骨感染，研究组无深部胸骨感染，差异无统计学意义。无手术相关死亡。
根据患者特点选择合适的胸骨固定与关闭方法可降低胸骨切口并发症的发生率。我们提出了一种个体化的胸骨固定与关闭选择策略，需要进一步的临床研究验证。
