Cheng W, Cameron D E, Warden K E, Fonger J D, Gott V L
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Ann Thorac Surg. 1993 Mar;55(3):737-40. doi: 10.1016/0003-4975(93)90285-p.
Median sternotomy is the most commonly used incision in cardiothoracic surgery. Closure of this incision is usually performed with parasternal wires, but alternate techniques have been proposed to improve closure stability. This study compares biomechanical stability of standard wire (No. 5 stainless steel) with that of three types of band closure: 5-mm Mersilene ribbon, 5-mm stainless steel band, and 5-mm plastic band. Eight bisected cadaver sterna were reapproximated using each method of sternal fixation and tested for biomechanical stability using an MTS Bionix 858 Biomechanical Tester. Loads of 50, 100, 150, and 200 Newtons (1 Newton = 1 kg.m/s2) were applied as a distracting force across the closure. A linear regression line of displacement as a function of increasing load was determined for each closure method; the slope of this line is inversely proportional to fixation stability. Displacement and load correlated linearly for each closure (r = 0.99). Mean slopes were 0.012 mm/Newton (95% confidence limits, 0.0098 to 0.0142 mm/Newton) for No. 5 stainless steel wire, 0.014 mm/Newton (95% confidence limits, 0.0118 to 0.0162 mm/Newton) for plastic band, 0.017 mm/Newton (95% confidence limits, 0.0148 to 0.0192 mm/Newton) for Mersilene ribbon, and 0.017 mm/Newton (95% confidence limits, 0.0148 to 0.0192 mm/Newton) for 5-mm steel band. No. 5 stainless steel wire provided the most stable closure, although statistical significance was achieved only in comparison with Mersilene ribbon and stainless steel band (p < 0.05). The superior stability of stainless steel wire closure may be due to tightening of the wires by twisting, which results in more tension across the reapproximated sternal halves than with other methods.
正中胸骨切开术是心胸外科手术中最常用的切口。该切口的闭合通常采用胸骨旁钢丝，但也有人提出了其他技术来提高闭合稳定性。本研究比较了标准钢丝（5号不锈钢丝）与三种类型束带闭合方式（5毫米的Mersilene带、5毫米不锈钢带和5毫米塑料带）的生物力学稳定性。使用每种胸骨固定方法对八个劈开的尸体胸骨进行重新对合，并使用MTS Bionix 858生物力学测试仪测试其生物力学稳定性。以50、100、150和200牛顿（1牛顿=1千克·米/秒²）的载荷作为贯穿闭合处的牵张力量。为每种闭合方法确定位移随载荷增加的线性回归线；该线的斜率与固定稳定性成反比。每种闭合方式的位移与载荷呈线性相关（r = 0.99）。5号不锈钢丝的平均斜率为0.012毫米/牛顿（95%置信区间，0.0098至0.0142毫米/牛顿），塑料带为0.014毫米/牛顿（95%置信区间，0.0118至0.0162毫米/牛顿），Mersilene带为0.017毫米/牛顿（95%置信区间，0.0148至0.0192毫米/牛顿），5毫米钢带为0.017毫米/牛顿（95%置信区间，0.0148至0.0192毫米/牛顿）。5号不锈钢丝提供了最稳定的闭合，尽管仅与Mersilene带和不锈钢带相比具有统计学意义（p < 0.05）。不锈钢丝闭合的卓越稳定性可能归因于通过扭转使钢丝收紧，这导致重新对合的胸骨两半之间的张力比其他方法更大。
