提高心脏手术中胸骨闭合的恢复效果及预后:400例患者使用缝合带与钢丝对比的早期结果
Enhancing recovery and outcomes of sternal closure in cardiac surgery: Early results of a 400-patient comparison of suture tapes and steel wires.
作者信息
Kumar Ujjawal, Aslam Usman, Phillips Tyler, Khalpey Zacharya, Khalpey Zain
机构信息
Department of Cardiac Surgery, HonorHealth, Scottsdale, Ariz.
Khalpey AI Lab, Applied & Translational AI Research Institute (ATARI), Scottsdale, Ariz.
出版信息
JTCVS Tech. 2025 May 4;31:97-104. doi: 10.1016/j.xjtc.2025.03.016. eCollection 2025 Jun.
BACKGROUND
Conventional steel wires may be inadequate for patients at high risk of sternal complications. We compared steel wires with a novel sternal closure system involving suture tapes, aiming to reduce sternal complications and enhance postoperative recovery, particularly in high-risk patients.
METHODS
A total of 400 consecutive patients undergoing cardiac surgery via median sternotomy were analyzed retrospectively. Steel wires were used for patients 1 to 200 and suture tapes were used for patients 201 to 400. Preoperative, intraoperative, and postoperative data were compared between the 2 groups of patients.
RESULTS
The 2 groups were generally similar in terms of preoperative characteristics. The suture tape group had lower rates of sternal wound infection (1% vs 5%) and sternal dehiscence (0% vs 6%). Postoperative hospital admission also was significantly shorter (7 days vs 10 days). Suture tape patients had significantly less pain at 14-day and 30-day follow-ups, with significantly lower opioid use (125 vs 175 morphine milligram equivalents).
CONCLUSIONS
Suture tape sternal closure was effective, reproducible, and safe. It showed significant advantages over steel wires, including lower rates of sternal infection, dehiscence, and postoperative pain, as well as decreased opioid usage, and shorter hospital admission and closure times. We demonstrate the significant potential of this novel sternal closure system, especially for patients susceptible to sternal complications. Extended follow-up will be vital to demonstrate long-term efficacy.
背景
传统钢丝可能不适用于胸骨并发症高危患者。我们将钢丝与一种涉及缝合带的新型胸骨闭合系统进行了比较,旨在减少胸骨并发症并促进术后恢复,尤其是在高危患者中。
方法
对400例连续接受正中开胸心脏手术的患者进行回顾性分析。第1至200例患者使用钢丝,第201至400例患者使用缝合带。比较两组患者术前、术中和术后的数据。
结果
两组患者术前特征总体相似。缝合带组的胸骨伤口感染率(1%对5%)和胸骨裂开率(0%对6%)较低。术后住院时间也明显缩短(7天对10天)。在14天和30天随访时,使用缝合带的患者疼痛明显减轻,阿片类药物使用量明显较低(125对175吗啡毫克当量)。
结论
缝合带胸骨闭合有效、可重复且安全。与钢丝相比,它显示出显著优势,包括较低的胸骨感染、裂开和术后疼痛发生率,以及减少阿片类药物使用量,缩短住院时间和闭合时间。我们证明了这种新型胸骨闭合系统的巨大潜力,尤其是对于易发生胸骨并发症的患者。延长随访对于证明长期疗效至关重要。
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