Kay H R, Goodman L R, Teplick S K, Mundth E D
Ann Thorac Surg. 1983 Dec;36(6):706-14. doi: 10.1016/s0003-4975(10)60283-4.
Thirty computed tomographic (CT) scans from 27 patients who had undergone median sternotomy were reviewed. A control group of 15 asymptomatic patients was studied either early (within 21 days) or late (46 days to 22 years) after sternotomy. Twelve patients with symptoms ranging from sternal click to obvious mediastinitis also were studied within 30 days of sternotomy. The CT findings were correlated with the patient's clinical course. Imperfect sternal closure (sternal step-offs and gaps) was found in 10 of the 15 asymptomatic patients. Focal retrosternal fluid collections, air, and hematomas were seen in more than 75% of the asymptomatic patients. Retrosternal abscess, presternal abscess, and sternal disruption were noted in 3 symptomatic patients. Computed tomography correctly diagnosed the extent of mediastinal abscess in all patients. In the 3 patients in whom there was a discrepancy between the CT scan and the clinical findings, the scan ultimately was shown to be correct. These results indicate that computed tomography is a valuable tool in diagnosing wound problems after sternotomy because it accurately depicts the extent and depth of the wound infection.
回顾了27例接受正中开胸手术患者的30份计算机断层扫描（CT）图像。对15例无症状患者组成的对照组在开胸术后早期（21天内）或晚期（46天至22年）进行了研究。还对12例出现从胸骨喀哒声到明显纵隔炎等症状的患者在开胸术后30天内进行了研究。CT检查结果与患者的临床病程相关。15例无症状患者中有10例存在胸骨闭合不全（胸骨错位和间隙）。超过75%的无症状患者可见胸骨后局灶性积液、积气和血肿。3例有症状的患者出现了胸骨后脓肿、胸骨前脓肿和胸骨断裂。计算机断层扫描正确诊断了所有患者纵隔脓肿的范围。在CT扫描结果与临床发现存在差异的3例患者中，最终显示扫描结果是正确的。这些结果表明，计算机断层扫描是诊断开胸术后伤口问题的一种有价值的工具，因为它能准确描绘伤口感染的范围和深度。
