Shrestha Oshan, Bohara Sujan, Chettri Suchit Thapa, Pandey Ashim, Acharya Utshab, Tiwari Ashish, Bhandari Nikesh, Kadel Prashiddha Bikram, Shrestha Kajan Raj
Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal.
Department of Cardiovascular Surgery, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
Ann Med Surg (Lond). 2025 Apr 4;87(5):2948-2962. doi: 10.1097/MS9.0000000000003259. eCollection 2025 May.
Wire closure is linear and provides a single point of support, while rigid fixation provides two-dimensional support and acts as an additional skeletal brace that holds the two hemisternum together. This property avoids the factors that make the wire closure unstable. This study aims to compare the outcomes of rigid fixation with wire closure to study the difference in recovery time, pain scores, and sternal complications.
Prospective protocol registration was done, and electronic databases were searched without using any search filters. Screening was performed by independent reviewers, and data was extracted from selected studies. Heterogeneity was assessed by the test, the effect model was chosen accordingly, and the effect measure was chosen as appropriate. Forest plots and funnel plots were used to give visual feedback.
The rigid fixation group had better healing scores at 3 months (MD: 0.8; 95% CI: 0.59-1.01; = 376; = 0%; = <0.00001) and at 6 months (MD: 0.71; 95% CI: 0.23-1.20; = 376; = 71%; = 0.004). The rigid fixation group had a better pain score at 3 months and had a lesser incidence of sternal dehiscence. However, rigid fixation group took 2.91 minutes longer for closure and had a 1.02-day shorter hospital stay on average.
Rigid fixation was found to be superior to the wire cerclage in regard to shorter hospital stay duration, sternal healing scores, postoperative pain up to 3 months, and sternal dehiscence complication among the obese population.
钢丝闭合是线性的，提供单点支撑，而刚性固定提供二维支撑，并作为额外的骨骼支架将两个半胸骨固定在一起。这一特性避免了导致钢丝闭合不稳定的因素。本研究旨在比较刚性固定与钢丝闭合的效果，以研究恢复时间、疼痛评分和胸骨并发症的差异。
进行前瞻性方案注册，在不使用任何搜索过滤器的情况下搜索电子数据库。由独立评审员进行筛选，并从选定的研究中提取数据。通过 检验评估异质性，相应选择效应模型，并适当选择效应量。使用森林图和漏斗图提供视觉反馈。
刚性固定组在3个月时愈合评分更好（MD：0.8；95%CI：0.59 - 1.01； = 376； = 0%； = <0.00001），在6个月时也更好（MD：0.71；95%CI：0.23 - 1.20； = 376； = 71%； = 0.004）。刚性固定组在3个月时疼痛评分更好，胸骨裂开的发生率更低。然而，刚性固定组闭合时间平均长2.91分钟，平均住院时间短1.02天。
在肥胖人群中，刚性固定在缩短住院时间、胸骨愈合评分、术后3个月内的疼痛以及胸骨裂开并发症方面优于钢丝环扎。
