自体肋骨移植在胸骨缺损重建中的应用

Application of autogenous rib graft in reconstruction of sternal defects

目的探讨自体肋骨移植方式在胸骨缺损重建过程中的应用。方法回顾性分析浙江大学附属第二医院自2003年3月至2014年3月期间13例行胸骨切除,并使用自体肋骨移植方式重建胸骨缺损患者的病例资料。结果 13例患者中,胸骨柄患者9例,胸骨体患者4例。术后病理证实:软骨肉瘤3例,骨髓炎3例,骨软骨瘤3例,淋巴瘤2例,骨巨细胞瘤1例,韧带样瘤1例。所有患者平稳度过围手术期。在长期随诊过程中,共有2例患者死亡,其中1例患者因非霍奇金淋巴瘤复发在术后6个月去世,另1例患者因心脏病在术后26个月去世;其余患者均胸廓塑形良好,未出现反常呼吸、外观畸形和胸廓不稳等情况。结论对于胸骨切除术后缺损的患者,建议使用自体肋骨移植的方式来重建缺损区域。

Objective To investigate the application of autogenous rib graft in reconstruction of sternal defects. Methods The clinical data of 13 patients undergoing sternal resection and repair of defects with autogenous rib from March 2003 to March 2014 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed. Results There were 9 patients with manubrium lesions and 4 patients with mesosternum lesions. The postoperative pathology confirmed there were 3 cases of chondrosarcoma, 3 cases of osteomyelitis, 3 cases of osteochondroma, 2 cases of lymphoma, 1 case of osteoclastoma and 1 case of desmoid tumor. All patients recovered well during perioperation. In the long-term follow-up, one patient with non-Hodgkin lymphoma died as a result of local recurrence 6 months after surgery, and another one died of cardiac disease 26 months after surgery. There was no chest deformity, abnormal respiration or thoracic instability among the remaining patients. Conclusions Autogenous rib graft may be a safe and effective way in the reconstruction of sternal defects after resection.