Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Laparoendosc Adv Surg Tech A. 2024 Oct;34(10):936-940. doi: 10.1089/lap.2023.0417. Epub 2024 Apr 17.
Bar stabilization during minimally invasive pectus excavatum repair (MIRPE) is critical to avoid dislodgement. Multiple techniques are described including stabilizers, wires, and sutures. This retrospective study compared bar movement and outcomes between existing techniques and ZipFix™, a biocompatible cable tie. Patients ≤20 years of age who underwent MIRPE with ZipFix between January 2021 and September 2022 were compared with historical controls who underwent repair by same surgeons between January 2018 and December 2020 using stabilizers or polydioxanone suture (PDS). Demographics, clinical details, and outcomes were compared using Kruskal-Wallis and chi-square tests. Of the 116 patients who underwent repair, 45 had bars secured with ZipFix (39%) and 71 (61%) were historical controls (35 stabilizer, 36 PDS). Median (interquartile range) age was 15 (14-16) years and Haller index was 3.9 (3.6-4.5). Nine (8%) patients required two bars. Haller index and use of second bar were comparable between stabilization techniques ( > .05). In total, 49 patients (40%) reported any pain at 1 month and this was similar between stabilization techniques ( = .45). Median bar movement was greater for bars secured with PDS than with ZipFix or stabilizers at 1 month (5.5 versus 2.3 versus 3.3°, = .010) and last follow-up (6.5 versus 2.1 versus 3.6°, < .001). One patient whose bar was secured with PDS required revision for dislodgement. Pectus bar stabilization with ZipFix is a safe alternative to metal stabilizers and both techniques are superior to suture stabilization alone. The use of ZipFix may be preferred given its lower cost and ease of use.
微创漏斗胸修复术（MIRPE）中肋骨固定对于避免移位至关重要。有多种技术可以实现，包括固定器、钢丝和缝线。本回顾性研究比较了现有的固定技术和 ZipFix™（一种生物相容性的电缆扎带）之间肋骨移动和结果的差异。2021 年 1 月至 2022 年 9 月间接受 MIRPE 并使用 ZipFix 的患者与 2018 年 1 月至 2020 年 12 月间由同一手术医生使用固定器或聚二氧杂环己酮缝线（PDS）进行修复的历史对照患者进行比较。使用 Kruskal-Wallis 和卡方检验比较了人口统计学、临床细节和结果。116 名接受修复的患者中，45 名患者的肋骨用 ZipFix 固定（39%），71 名（61%）为历史对照（35 名使用固定器，36 名使用 PDS）。中位数（四分位间距）年龄为 15 岁（14-16 岁），Haller 指数为 3.9（3.6-4.5）。9 名（8%）患者需要使用两根肋骨固定器。不同固定技术之间 Haller 指数和使用第二根肋骨固定器的情况相似（ > .05）。总共有 49 名（40%）患者在 1 个月时有任何疼痛，不同固定技术之间的疼痛情况相似（ = .45）。使用 PDS 固定的肋骨固定器在 1 个月和最后一次随访时的肋骨移动距离大于使用 ZipFix 或固定器的患者（5.5 度比 2.3 度比 3.3 度， = .010）。使用 PDS 固定的一名患者的肋骨固定器发生了移位，需要进行修复。ZipFix 固定用于漏斗胸肋骨固定是金属固定器的安全替代方法，这两种技术都优于单独使用缝线固定。考虑到 ZipFix 的成本更低且易于使用，可能更倾向于使用它。
