Hendrickson S C, Koger K E, Morea C J, Aponte R L, Smith P K, Levin L S
Division of Cardiothoracic Surgery, Duke University Medical Center 27710, USA.
Ann Thorac Surg. 1996 Aug;62(2):512-8.
Sternal nonunion, defined as sternal pain with clicking, instability, or both for more than 6 months in the absence of infection, is an uncommon complication of median sternotomy. Nonunion is frequently complicated by the presence of multiple transverse fractures, which make simple rewiring inadequate.
Six patients with debilitating pain secondary to sternal nonunion were treated with the technique of sternal plating between 1989 and 1995.
Sternal plating corrected sternal instability and provided excellent pain relief in all 6 patients. All patients reported an improved quality of life and were able to resume recreational activities. Two patients have had plate removal for late bursa formation. Sternal healing was complete in both instances.
Sternal plating, which is based on the tension-band principle, is an effective treatment of sternal nonunion. The technique is applicable to both simple and complex nonunions. The stainless steel plates resist bending stresses, and the cortical bone resists compressive forces. The technique requires minimal dissection of the posterior sternal border, is not circumferential, and provides secure sternal approximation.
胸骨不愈合定义为在无感染情况下，伴有弹响、不稳定或二者兼具的胸骨疼痛持续6个月以上，是正中开胸手术罕见的并发症。不愈合常并发多处横行骨折，使得单纯重新钢丝固定并不充分。
1989年至1995年间，对6例因胸骨不愈合导致严重疼痛的患者采用胸骨钢板固定技术进行治疗。
胸骨钢板固定纠正了胸骨不稳定，6例患者均获得了极佳的疼痛缓解效果。所有患者均表示生活质量得到改善，能够恢复娱乐活动。2例患者因后期滑囊形成而取出钢板。两例患者胸骨均完全愈合。
基于张力带原理的胸骨钢板固定术是治疗胸骨不愈合的有效方法。该技术适用于简单和复杂的不愈合情况。不锈钢钢板可抵抗弯曲应力，皮质骨可抵抗压缩力。该技术只需对胸骨后缘进行最小限度的解剖，无需进行环周操作，并能可靠地使胸骨对合。
