Hansen Adam J, Hayanga Jeremiah, Toker Alper, Badhwar Vinay
Department of Thoracic Surgery, West Virginia University Heart and Vascular Institute, Bridgeport, WVa.
JTCVS Open. 2024 Apr 28;19:347-354. doi: 10.1016/j.xjon.2024.03.007. eCollection 2024 Jun.
To evaluate results of sutured repair for slipping rib syndrome (SRS), identify failure points, and discuss technique modifications to improve outcomes through costal margin reconstruction (CMR).
Patients undergoing repair of SRS between February 2019 and February 2024 at an academic referral institution were retrospectively analyzed. Pain scores, quality of life, pain medication use, and reoperations were evaluated pre- and postoperatively at 1 and 6 months. In patients failing sutured repair we identified specific failure points and devised a new CMR technique to overcome them. Subsequent CMR patients were followed at 1, 6, 12, 18, and 24 months using the same outcome measures.
Four hundred forty-nine patients underwent repair. Two hundred forty-one patients underwent sutured repair with revision required in 66. Median time to revision was 14 months. CMR was developed and performed in 247 patients. In CMR patients, preoperative mean pain score of 7.5 out of 10 dropped postoperatively to 4.0, 2.5, 1.9, 1.3, and 0.9 at 1, 6, 12, 18, and 24 months, respectively ( < .001). Mean quality of life of 38% improved to 73%, 83%, 88%, 93%, and 95% at the same intervals ( < .001). Preoperatively, 29% of patients chronically used opioid medications. Opioid use dropped postoperatively to 11%, 4%, 4%, 0%, and 0% at the same intervals. Use of nonopioid medications followed a similar pattern. One CMR patient required full revision.
SRS is a debilitating, but correctable disorder. Improved pain and quality of life, reduction in chronic opioid use, and freedom from revision surgery suggest that CMR should be considered the standard operation for SRS.
评估缝合修复滑动肋综合征（SRS）的结果，确定失败点，并讨论通过肋缘重建（CMR）改善结果的技术改进。
对2019年2月至2024年2月在一家学术转诊机构接受SRS修复的患者进行回顾性分析。在术前以及术后1个月和6个月评估疼痛评分、生活质量、止痛药物使用情况和再次手术情况。对于缝合修复失败的患者，我们确定了具体的失败点，并设计了一种新的CMR技术来克服这些问题。随后，对接受CMR的患者在1、6、12、18和24个月时使用相同的结局指标进行随访。
449例患者接受了修复。241例患者接受了缝合修复，其中66例需要进行翻修。翻修的中位时间为14个月。247例患者开展并实施了CMR。在接受CMR的患者中，术前平均疼痛评分为10分中的7.5分，术后1、6、12、18和24个月分别降至4.0分、2.5分、1.9分、1.3分和0.9分（P<0.001）。相同时间间隔内，平均生活质量从38%分别提高到73%、83%、88%、93%和95%（P<0.001）。术前，29%的患者长期使用阿片类药物。术后相同时间间隔内，阿片类药物的使用分别降至11%、4%、4%、0%和0%。非阿片类药物的使用也呈现类似模式。1例接受CMR的患者需要进行完全翻修。
SRS是一种使人衰弱但可纠正的疾病。疼痛减轻、生活质量改善、慢性阿片类药物使用减少以及无需再次手术表明，CMR应被视为SRS的标准手术。
