探讨新型胸骨环抱器结合钢丝固定胸骨在成人心脏正中切口直视手术中的应用效果。

回顾性分析2016年1月至2017年12月期间在临沂市人民医院心脏血管外科接受手术治疗的328例心脏大血管疾病患者临床资料，按胸骨固定方法不同分为对照组159例和研究组169例。其中对照组采用传统的钢丝将锯开的胸骨左右两侧缝合，后收紧钢丝、合拢胸骨并拧紧钢丝，予以固定胸骨；研究组采用钢丝对合锯开胸骨的基础上放置新型环抱器固定胸骨。分析2组患者关胸时间(关胸开始到皮肤切口缝合结束的时间)、二次开胸止血(胸骨相关)率、术后24 h引流量、术后切口、胸骨感染或胸骨裂开率、术后胸痛不适发生率以及术后住院时间。患者出院后通过门诊、电话询问进行随访。数据比较采用t检验和χ²检验。

关胸术后，对照组1例患者因急性A型主动脉夹层术后急性肾功能衰竭死亡，其余所有患者均痊愈出院。研究组患者关胸时间(32.3±7.3) min，明显少于对照组(51.5±8.4) min，差异有统计学意义(t＝－22.113，P<0.05)。胸骨相关的二次开胸止血，研究组发生1例，而对照组发生6例，2组比较差异有统计学意义(χ²＝3.969，P＝0.046)。研究组术后24 h引流量(372.8±213.1) mL，少于对照组(538.9±202.6) mL，2组比较差异有统计学意义(t＝－7.224，P<0.05)。研究组术后未见切口和胸骨感染和(或)裂开，而对照组感染和(或)裂开共7例，其中胸骨裂开4例，早期予以新型环抱器重新固定胸骨，治愈出院；切口感染2例，予以换药后重新缝合切口后治愈；胸骨感染1例，予以胸骨清创加胸大肌肌瓣转移手术后康复出院，2组比较差异有统计学意义(χ²＝7.599，P<0.05)。研究组术后出现胸痛不适2例，而对照组7例，2组比较差异有统计学意义(χ²＝4.101，P＝0.043)。研究组患者术后住院时间(8.6±4.1) d，少于对照组(10.5±3.4) d，2组比较差异有统计学意义(t＝－4.467，P<0.05)。患者出院后随访(11.3±4.9)个月，所有患者均未见胸骨感染及裂开。

新型胸骨环抱器结合钢丝固定胸骨手术切口，与传统手术相比操作简单、固定牢固，在缩短关胸手术时间、减少术后切口并发症、缩短住院时间等方面优势明显，可以广泛使用于成人心脏外科正中手术切口。

To investigate the effect of a new sternum embracing fixator combined with wire to fixed sternum in the direct incision surgery of the adult heart.

A retrospective analysis was performed on 328 patients with cardiac vascular disease who underwent surgical treatment in the Department of Cardiovascular Surgery, Linyi People′s Hospital from January 2016 to December 2017. Based on the sternal fixation methods, those patients were divided into two groups: control group 159 cases and study group 169 cases. The control group used traditional steel wire to suture the left and right sides of the sawed sternum, and then tightened the steel wire, closed the sternum and tightened the steel wire to fix the sternum; the study group used wire-pair saw to open the sternum and placed a new embracing fixator to fix the sternum. The time of chest closure (the time from the beginning of the chest to the end of the skin incision suture), the rate of secondary thoracotomy (sternal correlation), the drainage at 24 h after surgery, the postoperative incision, sternum infection or sternal rupture rate, and postoperative chest pain or discomfort rate and postoperative hospital stay were analyzed. After the patients discharged from the hospital, follow-up was conducted through outpatient and telephone inquiries. Data were analyzed by t test and chi-square test.

After the operation of the chest, one patient in the control group died of acute renal failure after acute type A aortic dissection, and all the other patients were cured and discharged. The time of chest closure in the study group was (32.3±7.3) min, which was significantly lower than that in the control group (51.5±8.4) min, the difference was statistically significant (t=-22.113, P<0.05). Sternal related secondary thoracotomy for hemostasis occurred in 1 case in the study group and 6 cases in the control group, the difference between the two groups was statistically significant (χ²=3.969, P=0.046). The drainage volume of the study group was (372.8±213.1) mL at 24 h after operation, which was less than that of the control group (538.9±202.6) mL, the difference was statistically significant (t=-7.224, P<0.05). There were no infection and(or) rupture of the incision and sternum in the study group. In the control group, there were 7 cases of infection and(or) rupture, including 4 cases of sternal rupture, the new circumcision was used to re-fix the sternum and all the 4 patients were cured; 2 cases of wound infection were treated with re-surgery and incision after dressing change; sternal infection in 1 case, the sternal debridement and pectoralis major muscle flap transfer were performed and the patients were discharged from the hospital. The difference between the two groups was statistically significant (χ²=7.599, P<0.05). There were 2 cases of chest pain discomfort in the study group, and 7 cases in the control group, the difference was statistically significant (χ²=4.101, P=0.043). The postoperative hospital stay in the study group was (8.6±4.1) d, which was lower than than the control group (10.5±3.4) d, the difference was statistically significant (t=-4.467, P<0.05). Patients were followed up (11.3±4.9) months after discharge, and all patients had no sternal infection and rupture.

The new sternum embracing device combined with wire-fixed sternal incision is simple and stable compared with traditional surgery. It has obvious advantages in shortening the time of chest surgery, preventing and reducing postoperative incision complications, and shortening hospital stay. It can be widely used in midline surgical incision in adult cardiac surgery.