Gurz Selcuk, Dost Burhan, Pirzirenli Mehmet Gokhan, Buyukkarabacak Yasemin, Taslak Sengul Aysen, Kaya Cengiz, Temel Necmiye Gul, Ozdemir Emine, Basoglu Ahmet
Department of Thoracic Surgery, Ondokuz Mayis University, Medical Faculty, Samsun, Turkey.
Department of Anaesthesiology and Reanimation, Ondokuz Mayis University, Medical Faculty, Samsun, Turkey.
Interdiscip Cardiovasc Thorac Surg. 2024 Mar 29;38(4). doi: 10.1093/icvts/ivae039.
Isolated sternal fractures are rare pathologies that rarely require surgical fixation. Although different fixation techniques are used, it is routinely performed under general anaesthesia. In our study, we aimed to share the details of the awake sternal fixation technique performed in our clinic and to compare the early results with sternal fixation methods performed under general anaesthesia.
Between January 2009 and January 2023, 129 patients who were diagnosed with sternal fracture and who underwent investigations and follow-up in our clinic were evaluated retrospectively. Thirteen patients who underwent surgical fixation for isolated sternal fracture were included in the study. Patients were categorized according to fixation and anaesthetic technique; group 1: fixation with steel wire under general anaesthesia (n = 4), group 2: fixation with titanium plate-screw under general anaesthesia (n = 4) and group 3: fixation with awake titanium plate-screw with parasternal intercostal plane block (n = 5). Demographics, surgical indication, radiological findings, surgical incision, surgical time and hospital stay were statistically compared.
The mean age of the patients included in the study was 55.15 ± 15.01 years and 84.6% (n = 11) were male. The most common reason for fixation was displaced fracture (53.8%). Fixation surgery was performed due to pain in 30.8% (n = 4) and non-union in 15.4% (n = 2) of the fractures. The mean duration of surgery were 98.75 ± 16.52, 77.5 ± 35 and 41 ± 14.74 min, respectively. Duration of surgery was significantly lower in group 3 compared to the other groups (P = 0.012). The hospital stay duration for group 1 was 6 days, group 2 was 4 days and group 3 was 1 day. A notable difference was observed among all groups (P = 0.019).
Awake sternal fixation technique with titanium plate-screw system under superficial parasternal intercostal plane block is an easy and effective method for surgical treatment of isolated sternal fractures. This technique showed a direct positive effect on the duration of surgery and hospital stay.
孤立性胸骨骨折是一种罕见的病症，很少需要手术固定。尽管使用了不同的固定技术，但通常在全身麻醉下进行。在我们的研究中，我们旨在分享在我们诊所进行的清醒胸骨固定技术的细节，并将早期结果与在全身麻醉下进行的胸骨固定方法进行比较。
回顾性评估2009年1月至2023年1月期间在我们诊所诊断为胸骨骨折并接受检查和随访的129例患者。13例因孤立性胸骨骨折接受手术固定的患者被纳入研究。根据固定和麻醉技术对患者进行分类；第1组：全身麻醉下钢丝固定（n = 4），第2组：全身麻醉下钛板螺钉固定（n = 4），第3组：在胸骨旁肋间平面阻滞下清醒钛板螺钉固定（n = 5）。对人口统计学、手术指征、影像学表现、手术切口、手术时间和住院时间进行统计学比较。
纳入研究的患者平均年龄为55.15±15.01岁；84.6%（n = 11）为男性。固定的最常见原因是移位骨折（53.8%）。30.8%（n = 4）的骨折因疼痛进行固定手术，15.4%（n = 2）的骨折因骨不连进行固定手术。手术平均时长分别为98.75±16.52、77.5±35和41±14.74分钟。与其他组相比，第3组的手术时长显著更短（P = 0.012）。第1组的住院时长为6天，第2组为4天，第3组为1天。所有组之间观察到显著差异（P = 0.019）。
在胸骨旁肋间平面阻滞下采用钛板螺钉系统进行清醒胸骨固定技术是治疗孤立性胸骨骨折的一种简便有效的手术方法。该技术对手术时长和住院时间有直接的积极影响。
