胸骨结扎带固定胸骨在成人前正中切口心脏手术中的应用研究

Application of sternal closure with ZipFix system for adult patients undergoing cardiac surgery through median sternotomy

目的总结胸骨结扎带固定胸骨在成人前正中切口心脏手术中的应用经验,并评价其安全性和疗效。方法50例接受前正中切口心脏手术患者,在关胸时使用胸骨结扎带固定胸骨(结扎带组),同期使用钢丝固定胸骨的50例患者(钢丝组),分析两组关胸耗材数量和费用、关胸手术时间、术后切口并发症等指标。结果结扎带组使用2~4条结扎带固定胸骨,关胸手术时间8~15min,术后未出现切口并发症。钢丝组使用2~3条(4~7针)钢丝固定胸骨,关胸手术时间10~20min,术后3例出现胸骨哆开(1例钢丝断裂、2例钢丝切割),并有3例胸骨无松动患者出现胸部切口愈合不良。结扎带组关胸耗材数量和费用高于钢丝组,关胸手术时间和术后切口并发症少于钢丝组(P<0.05)。结论在成人前正中切口心脏手术中应用胸骨结扎带固定胸骨,效果确切,可显著缩短关胸手术时间,减少术后切口并发症。

Objective To summarize the application experience of sternal closure with Zip Fix system for adult patients undergoing cardiac surgery through median sternotomy,and to evaluate its safety and curative effect.Methods Fifty adult patients undergoing cardiac surgery through median sternotomy with Zip Fix system for sternal closure were defined as Zip Fix group.Other 50 patients in the same period with steel wire for sternal closure were defined as steel wire group.The indexes such as the amount and the cost of material for sternal closure,the operation time of sternal closure and the postoperative complications of sternotomy were analyzed in the two groups.Results In the Zip Fix group,the sternum was fixed with 2 to 4 pieces of ligation band,and the operation time of sternal closure was 8 to 15 minutes.No complication of sternotomy occurred after cardiac surgery.In the steel wire group,the sternum was fixed with 2 to3 pieces of steel wire( 4 to 7 needles),and the operation time of sternal closure was 10 to 20 minutes.Sternal dehiscence was found in 3 patients including 1 patient with ruptured steel wire and 2 patients with cutting-through of the steel wire,and poor wound healing was found in 3 patients without sternal separation in the steel wire group.The amount and the cost of material for sternal closure in the Zip Fix group were significantly higher than those in the steel wire group( P < 0. 05),but the operation time of sternal closure and the postoperative complications of sternotomy in the Zip Fix group were significantly less than those in the steel wire group( P < 0. 05).Conclusion The application of sternal closure with Zip Fix system for adult patients undergoing cardiac surgery through median sternotomy is effective,which can significantly shorten the operation time of sternal closure and reduce the postoperative complications of sternotomy.