钛板联合钢丝双重固定胸骨切口在心脏直视手术中的应用研究

摘要

To summarize the clinical experience of sternotomy closure using titanium plate and wire fixation in open heart surgery, and evaluate its safety and clinical outcome. Methods From January 2010 to December 2010, 90 patients with heart and great artery diseases received open heart surgery in our hospital were divided averagely into the wire fixation group (Group A) , titanium plate fixation group (Group B) , titanium plate and wire fixation group (Group C) by sternotomy closure technique. The clinical indices including the sternotomy closure procedure time, the quantity of postoperative first 24 hours drainage, the rate of postoperative incision complications, the postoperative hospital stay time and the maintenance charge in three groups were observed and compared. Results Compared with Group A, the sternotomy closure procedure time in Group B and Group C was significantly shortened(P <0. 05) , the maintenance charge in Group B and Group C was significantly increased(P < 0.05) . Compared with Group C, the postoperative hospital stay time in Group A and Group B was significantly prolonged(P <0. 05) , the rate of postoperative incision complications such as infection, sternum dehiscence, chest pain or upset in Group A and Group B was significantly increased(P <0. 05) . There was no statistical difference in the quantity of postoperative first 24 hours drainage of three groups (P > 0. 05) . Conclusion Using titanium plate and wire fixation sternotomy is simple and firm. It canshorten the sternotomy closure procedure time and decrease the rate of postoperative incision complications. It should be widely appli-cated in open heart surgery.%目的 总结钛板联合钢丝双重固定胸骨切口在心脏直视手术中的应用经验,并探讨其安全性和临床效果.方法 选择2010年1月-2010年12月期间在我科接受手术治疗的90例心脏大血管疾病患者,按胸骨切口固定方法 不同,分为钢丝固定组(A组)、钛板固定组(B组)和钛板联合钢丝双重固定组(C组),每组30例,观察比较三组关胸手术时间、术后24h引流量、术后切口感染或胸骨裂开发生率、术后胸痛或不适发生率、术后住院时间、住院费用等临床指标.结果 B组和C组的关胸手术时间短于A组.但住院费用却高于A组,差异有统计学意义(P<0.05);A组和B组术后住院时间长于C组,术后切口感染或胸骨裂开发生率、术后胸痛或不适发生率均高于C组,差异有统计学意义(P<0.05);三组间术后24h引流量比较,差异无统计学意义(P>0.05).结论 钛板联合钢丝双重固定胸骨切口,操作简单,固定牢靠,可以缩短关胸手术时间,减少术后切口并发症,值得临床推广.