胸骨横断切口中钛板固定的应用

摘要

目的 比较钛板固定系统在胸骨横断切口中与传统钢丝固定的区别.方法 对2005年1月至2009年12月期间收治的249例胸骨横断切口行胸腺和胸腺瘤切除的重症肌无力患者进行回顾性分析,其中钢丝缝合胸骨120例(钢丝组),应用钛板固定系统129例(钛板组),并比较两组患者的胸骨愈合情况.结果 术后短期(1周内):(1)钛板组患者的胸骨稳定性明显优于钢丝组(P＜0.01)；(2)钛板组患者术后疼痛评分平均为3.79±1.31,低于钢丝组的4.48±1.43(P＜0.01)；(3)钛板组患者平均下床活动时间为(2.78±0.79)天,早于钢丝组的(3.59±0.89)天(P＜0.01)；(4)两组间的表面伤口延期愈合无明显差异(P＞0.05).术后长期(6周以上):钛板组的胸骨愈合率优于钢丝组(P＜0.05).结论 钛板固定系统对胸骨断端的固定呈高强度三维固定.在胸骨横断的手术患者中使用钛板固定系统能有效提高术后患者的胸骨稳定性,减轻患者术后疼痛,增强患者活动能力,降低远期胸骨不愈发生率,较传统钢丝固定有明显优势.%Objective To compare the difference between titanium plate fixation system and steel wire fixation in sternum transverse incisions. Methods Sternal healing status was reviewed in 249 patients with myasthenia gravis that underwent thymectomy or excision of thymoma from Jan. 2005 to Dec. 2009. Sternum transverse incision was adopted in all these patients. One hundred and twenty patients received steel wire fixation of the sternum, and the rest applied titanium plate fixation. A comparison of sternal healing status was made between the two groups. Results Short-term (within 1 week after surgery) results: (1) The stability of the sternum in the titanium plate group was significantly superior to that in the steel wire group (P<0. 01); (2) The average pain score in the titanium plate group (3.79 ±1.31) was obviously lower than that in the steel wire group (4.48±1.43, P<0. 01); (3) The average out-of-bed time after surgery in the titanium plate group (2. 78 ± 0. 79 days) was earlier than that in the steel wire group (3. 59 ± 0. 89 days, P<0. 01) ; (4) There was no significant difference in delayed wound healing between the two groups (P>0. 05). Long-term (6 weeks after surgery or longer) result: The sternal healing rate in the titanium plate group was significantly higher than that in the steel wire group ( P<0. 05 ). Conclusions Biomechanically, the titanium plate fixation system could provide high intensity three diamensional fixation. In patients who underwent sternum transverse incisions for thymectomy and/or excision of thymoma, the introduction of titanium plate fixation system can effectively improve the postoperative sternal stability, relieve postoperative pain, enhance the patient's physical activity and decrease the long-term nonunion rate of the sternum. Therefore,it has significant advantages over the conventional method of steel wire fixation.