钛板在老年人非体外循环冠状动脉旁路移植术胸骨固定中的应用研究

Application of titanium fixation plates for sternum closure after off-pump coronary artery bypass grafting in elderly patients

目的 研究钛板在老年人非体外循环冠状动脉旁路移植术胸骨固定中的作用.方法 接受非体外循环冠状动脉旁路移植术老年患者120例随机分为两组,其中对照组60例,术中采用单纯钢丝固定胸骨,实验组60例,采用钛板联合钢丝固定胸骨.观察并记录两组患者手术关胸时间、术后术口疼痛率、胸骨裂开率以及胸骨再固定术的发生率.结果 实验组术后术口疼痛率（11.7％,7/60）低于对照组（38.3％,23/60）（χ2=11.378,P＜0.05）;实验组的术后胸骨裂开发生率（3.3％,2/60）低于对照组（13.3％,8/60）（χ2=3.927,P＜0.05）;实验组胸骨再固定术的发生率（1.7％,1/60）低于对照组（11.7％,7/60）（χ2=4.821,P＜0.05）.实验组的关胸时间（39±5）min比对照组（30±2）min延长（χ2=13.386,P＜0.05）.结论 钛板联合钢丝固定胸骨增加了老年人非体外循环冠状动脉旁路移植术的关胸时间,但是比钢丝固定胸骨的稳定性增加,术口疼痛减轻,胸骨裂开率降低,从而降低了胸骨再固定的风险.

Objective To investigate the role of titanium plate fixation for sternum closure after off-pump coronary artery bypass grafting （OPCABG） in elderly patients.Methods A total of 120 elderly patients who accepted OPCABG were randomly divided into two groups.The control group （n =60） received wire to fix the sternum,and the experimental group （n=60） received titanium plate combined with wire to fix the sternum.The chest closure time,the rate of postoperative incision pain,the rate of sternal dehiscence and sternal re-fixation between two groups were observed and recorded.Results The rates of postoperative incision pain,sternal dehiscence,sternal re-fixation was lower in experimental group than in control group [11.7%（7/60） vs.38.3%（23/60）,3.3%（7/60） vs.13.3%（8/60）,1.7%（1/60） vs.11.7%（7/60）,χ2 =11.378,3.927,4.821 respectively all P〈0.05].The chest closure time was longer in experimental group than in control group [（39±5）min vs.（30±2） min,χ2 =13.386,P〈0.05].Conclusions Titanium fixation plate combined with wire for sternum closure can increase the stability of sternum fixation,reduce the postoperative pain and sternal dehiscence,and then decrease the risk of sternal re-fixation,but delay sternal closure of OPCABG in the elderly.