Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

Comparison of Sternal Wound Complication after Off-Pump CABG between Skeletonized and Pedicled LIMA Harvesting: A Single Centre Experience in Bangladesh

Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.

带蒂大网膜移植术治疗恶性肿瘤放射性胸部溃疡并胸骨骨髓炎的临床疗效分析

目的探讨带蒂大网膜移植术治疗恶性肿瘤放射治疗(放疗)后引发的胸部溃疡并胸骨骨髓炎的临床疗效。方法回顾性分析4例恶性肿瘤放射性胸部溃疡并胸骨骨髓炎患者的临床资料,均行带蒂大网膜移植手术治疗,观察治疗效果。结果4例患者均顺利实施手术治疗,手术时间85~150 min,出血量200~700 ml,住院天数22~99 d。1例患者术后溃疡面积明显缩小,仅残留针状窦道,出院后门诊换药6个月后治愈;其余患者均顺利治愈出院,无二次手术。1例患者术后1年因肺癌肝转移死亡,其余3例随访至今胸骨骨髓炎无复发。结论对于恶性肿瘤放射性胸部溃疡并胸骨骨髓炎患者,带蒂大网膜移植术是一种安全有效的手术方式。

右腋下小切口与胸骨正中切口两种入路方式治疗先天性心脏病患儿的效果观察

目的探讨先天性心脏病患者采取不同入路手术治疗的临床价值。方法抽取洛阳市中心医院2021年1月至2023年12月收入的先天性心脏病患儿70例,依据不同手术方式分为对照组与观察组,各35例,对照组接受胸骨正中切口,观察组接受右腋下小切口,对两组患儿临床指标(手术时间、体外循环时间、输血量、胸腔引流量、主动脉阻断时间、住院时间),疼痛程度,呼吸功能及并发症发生情况进行组间比较。结果两组患儿手术时间、体外循环时间、主动脉阻断时间相比,差异无统计学意义(P>0.05),观察组输血量、胸腔引流量均低于对照组,且住院时间短于对照组,差异有统计学意义(P<0.05);两组患儿各时间段呼吸功能指标相比,差异无统计学意义(P>0.05);观察组患儿各时间段疼痛程度评分均低于对照组,差异有统计学意义(P<0.05);两组患儿并发症发生风险相比,差异无统计学意义(P>0.05)。结论两种手术入路方式均可治疗先天性心脏病,且与胸骨正中切口相比,右腋下小切口不会影响患儿呼吸功能,且可改善疼痛程度,促进患儿快速康复,安全性较高,值得临床应用。

深部胸骨切口感染预防及治疗的研究进展

深部胸骨切口感染(DSWI)是正中胸骨切开术后罕见但严重的一种并发症。DSWI的治疗周期长,预后不理想,对患者的生活质量和心理健康造成了一定影响。该现状的改善需要临床医师的多学科合作,医师术前及时识别危险因素,并采取有效的预防措施,术后一旦发现切口感染及时处理,可避免感染进展到胸骨及纵膈。在明确DSWI的情况下,整形外科医师选择适合患者的治疗方案,及时控制感染实现胸骨重建。目前,DSWI的预防尚未引起足够的重视,治疗多依赖于医师自身的经历与理解,缺乏共识。该文对DSWI的预防和治疗的相关进展作一综述。

Sternal Reconstruction of Deep Sternal Wound Infections Following Median Sternotomy by Single-stage Muscle Flaps Transposition

Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males(73.7%) and 5 females(26.3%), aged 55±13(18-78) years. According to the Pairolero classification of infected median sternotomies, 3(15.8%) patients were type II, and the other 16(84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients(78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients(21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients(10.5%) presented with subcutaneous infection, and 3 patients(15.8%) had hematoma. They recovered following local debridement and medication. 17 patients(89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.

Early Repair of Sternal Instability Prevents Mediastinitis

Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.

Surgical Resection of Sternal Tumors and Reconstruction with Titanium Mesh

Objective To evaluate the use of titanium mesh reconstruction after sternal tumor resection. Methods From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed. Results Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed. Conclusions Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.

Sternal metastasis-the forgotten column and its effect on thoracic spine stability

Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management:(1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and(2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.

Congenital sternal foramen in a stillborn Holstein calf

Congenital sternal foramen is an anomaly whose occurrence is rare in human but is especially unusual in animals.This defect was formed when fusion of multiple ossification centers was incomplete.It may be associated with other lesions in body organs especially cardiac anomalies.In the present study,we report a very rare case of congenital sternal foramen in a Holstein calf.The oval defect was like a gunshot wound and located at the lower third of the sternum.Apparently,the rest of skeleton system seems normal.The awareness of the anomaly is important for better diagnosis and treatment of diseases.

Resternotomy Following Sternal Bone Cement Implantation: A Great Challenge for Cardiac Surgeons

Background: Median sternotomy and resternotomy is the standard technique for coronary artery bypass grafting (CABG), valvular heart disease, and congenital heart disease. Despite ad-vances in many areas of cardiac surgical procedures, there is a lack of innovation in sternal closure techniques. Several studies have examined sternal closure techniques including wiring, interlocking, plate and screw, and bone cementation. However, none of them achieved widespread acceptability. On one hand, serious post-operative complications are associated with the use of wiring and plating techniques in high-risk patients. The aim of this study is showing challenges and difficulties with resternotomy in patient with a history of previous cardiac surgery and usage of biologic bone cements. Case Report: The case was a 56-year-old woman with a history of previous sternotomy for mitral and aortic valve replacement (mechanical sj. No. 29 and mechanical sj. No. 21, respectively) using biologic bone cement (Kryptonite TM, Doctors Research Group Inc.) for her osteopenic sternum. Four years after the mitral valve replacement (MVR), she was referred to emergency department with a thrombosis at the mitral valve. She under-went emergent cardiac surgery with a very difficult resternotomy under femoral cannulation support. Conclusion: Resternotomy in patients with previous sternotomy with Kryptonite bone cements or calcium phosphate cements (CPC) is safe and can be done similar to other cardiac reoperations. It seems that reoperation in this patients does not increase the risk of bleeding, morbidity, and mortality.

Combined application of Robicsek procedure and thermoreactive nitinol clips for treating a patient with sternal dehiscence

Postopereative sternal dehiscence is one of the most important complications of median sternotomy which may cause pulmonary dysfunction and mediastinitis. We are reporting a patient with sternal dehiscence after coronary artery bypass surgery that underwent application of thermoreactive nitinol clips in addition to Robicsek procedure. Using thermoreactive nitinol clips method together with Robicsek procedure may be a valuable technique for preventing recurrent sternal dehiscence for patients who are candidates of noninfective recurrent sternal dehiscence.

Prevention of Sternal Dehiscence Following Use of Bilateral Internal Mammary Arteries in OPCAB

Purpose: We harvested bilateral Internal Mammary Arteries and made LIMA-RIMA Y in all the patients undergoing OPCAB at our center irrespective of the presence or absence of various risk factors for sternal dehiscence. The purpose of this study was to find an effective way of sternal closure in patients undergoing OPCAB with both the Internal Mammary Arteries harvested for grafting. Method: The patients who did not have any risk factors were placed in group I and all of them had a standard six wire closure of sternotomy. The patients having any risk factors were placed in group II. The patients in group II were randomized by including every alternate patient from group II to subgroup II A and every other alternate patient from group II to subgroup II B. Patients in subgroup II A again had a standard closure of sternotomy while in patients of subgroup II B bilateral Robiscek repair and four-five interlocking figure of eight wires were used for closure of sternotomy. Results: The patients who had risk factors for sternal dehiscence had higher risk for sternal dehiscence as compared to patients without any risk factors if bilateral Internal Mammary Arteries were harvested for OPCAB. But if we used bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure then the rate of sternal complications in the patients with risk factors for sternal dehiscence was not more than the patients without risk factors. Conclusion: We can harvest bilateral Internal Mammary Arteries for OPCAB without fear of sternal complications even in patients with high risk for sternal dehiscence if we use bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure.

Lung Adenocarcinoma Presenting as a Bleeding Sternal Mass

A 53-year-old man with bleeding from a sternal mass associated with a toxic syndrome. Computed tomography (CT) revealed a destructive sternal mass, bilateral pleural effusion and an endobronchial lesion in the right middle lobe bronchus. Immunohistopathological study of an incisional biopsy confirmed metastasic lung adenocarcinoma.

Deep Sternal Wound Infections after Coronary Artery Bypass Grafting: Analysis of 29 Cases from Iraq

Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m2. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.

Acute Presentation of Massive Retrosternal Thyrotoxic Goitres

Approximately 5% of goitres extend below the thoracic inlet and can potentially become life threatening due to compression of the airway and major vessels. Approximately 7% of these goitres which require surgical resection will need an additional sternotomy to deliver the intra-thoracic component. Massive retrosternal toxic goitres presenting acutely are rare and are described infrequently in literature. We hereby present two cases of massive retrosternal thyrotoxic goitres presenting with acute respiratory failure, requiring non-invasive ventilation, as well as significant head and neck venous compression. Surgery on the thyrotoxic patient with a goitre, even if not significantly enlarged, is associated with a high peri-operative mortality due to cardiac instability and hemorrhage. We discuss the challenges of surgical intervention in these patients with particular emphasis on the timing of surgery to relieve compressive symptoms and the time needed to achieve a euthyroid state. We also emphasize the need for meticulous hemostasis, use of a cell-saver, transfusion protocols, adjuncts to hemostasis, as well as careful monitoring and continuous adjustments to the coagulation profile.

Intraoperative vs 24-Hour Administration of Cefamandole to Prevent Deep Sternal Wound Infection and Endocarditis after Adult Cardiac Surgery

Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.

切开复位内固定治疗胸骨骨折合并肋软骨骨折的疗效

目的探讨切开复位内固定手术治疗胸骨骨折合并肋软骨骨折的疗效。方法回顾性分析2013年10月—2021年9月联勤保障部队第九〇九医院心胸外科收治的胸骨骨折合并肋软骨骨折患者78例,男性43例,女性35例;年龄18~60岁,平均42.0岁。胸骨角骨折14例,胸骨体骨折64例;单侧肋软骨骨折42例,双侧肋软骨骨折36例;患者均合并纵隔挫伤。受伤至手术时间0~2d,平均1.1d。根据胸部固定方式不同分为治疗组(46例)和对照组(32例),治疗组行骨折切开复位内钢板固定手术,对照组行胸部护板胸壁外固定术。比较术前5min和术后1~7d静息和咳嗽咳痰时疼痛数字评分量表(numerical rating scale,NRS)评分,相应时间点第一秒用力呼气容量(forced expiratory volume in the first second,FEV1)和FEV1占用力肺活量百分比(forced expiratory volume in the first second/forced vital capacity,FEV1%),疼痛持续时间,总住院时间,骨痂形成时间,术后肺部感染并发症发生率以及术前5min及术后1、3、6个月和末次随访健康状况调查简表(short-form 36 health survey scale,SF-36)评分。结果患者均获随访12个月,两组患者术前5min静息时NRS评分[(8.8±0.3)分vs.(8.7±0.4)分],咳嗽咳痰时NRS评分[(9.0±0.5)分vs.(9.1±0.4)分],差异无统计学意义(P>0.05)。术后1~7d静息和咳嗽咳痰时NRS评分比较差异有统计学意义(P<0.001)。两组患者术前5minFEV1[(1.8±0.2)L vs.(1.7±0.3)L],FEV1%[(56.3±7.7)%vs.(55.6±8.5)%]比较差异无统计学意义(P>0.05)。术后1~7d相应时间点FEV1、FEV1%比较差异有统计学意义(P<0.001)。治疗组较对照组疼痛持续时间短[(7.9±0.8)d vs.(16.9±0.5)d],总住院时间短[(7.5±1.8)d vs.(10.7±1.9)d],骨痂形成时间短[(2.5±0.4)周vs.(3.2±0.8)周],术后肺部感染发生率低(6.5%vs.21.8%),差异有统计学意义(P<0.001)。两组术前5min SF-36评分[(53.3±2.7)分vs.(54.6±3.5)分],差异无统计学意义(P>0.05)。与对照组比较,治疗组术后1个月[(73.4±10.9)分vs.(64.7±11.6)分]、3个月[(85.6±8.7)分vs.(78.2±11.4)分]、6个月[(87.6±5.1)分vs.(82.5±7.8)分]、末次随访[(88.6±5.4)分vs.(84.3±3.9)分]患者生活质量评分均提升,差异有统计学意义(P<0.001)。结论切开复位内固定手术治疗胸骨骨折合并肋软骨骨折可缓解疼痛,促进肺功能恢复,缩短总住院时间及术后骨痂形成时间,降低术后肺部感染的发生率,改善患者的生活质量。

比较两种预测小儿中心静脉导管置管深度方法——高度公式引导法与胸骨角引导法

目的:比较高度公式引导法与胸骨角引导法预测小儿中心静脉导管(CVC)置管深度方法的效果差异。方法:回顾性分析2014年1月至2021年1月接受右颈内静脉导管术205例的儿童资料,使用胸骨角引导(S组)101例,使用高度公式引导(H组)104例。比较两组人口统计学特征、导管尖端到心尖的距离、CVC尖端和心尖的相对位置、术后相关并发症及尖端位置的术后调整。结果:与H组相比,S组的CVC头端到心窝的垂直长度明显浅(-8.93±6.41 mm vs.3.76±13.35 mm,P<0.001),且CVC头端高于心窝的数量更多(98.0%vs.47.1%,P<0.001)。在S组中无患儿需要在术后调整CVC位置,也无并发症发生。H组术后需要调整CVC位置4例,其中与CVC相关的心律失常3例,导管功能障碍1例。结论:胸骨角引导法可能是比高度公式引导法预测小儿中心静脉置管深度更安全的方法。

Cantrell五联症患儿胸骨缺损的外科治疗

目的总结Cantrell五联症(pantelogy of Cantrell)患儿胸骨缺损的修补方法及临床疗效,以优化其外科治疗策略。方法回顾性分析2009年1月至2022年12月于上海交通大学医学院附属上海儿童医学中心接受外科治疗的11例Cantrell五联症患儿临床资料,患儿一期手术时年龄为181 d(49,343)d,手术时体重为(7.9±4.9)kg。11例均存在胸骨下段缺损及先天性心脏结构畸形,其中完全型Cantrell五联症7例,不完全型Cantrell五联症4例;均接受一期心脏回纳及胸骨重建手术。根据胸骨修复方式分为直接缝合组(n=6)和非直接缝合组(n=5);非直接缝合组中,采取GORE-TEX?补片修补3例,人造胸骨1例,钛网修复1例。根据患儿一期心脏回纳术前影像学资料,测量胸廓前壁正中膈肌水平处的胸廓横径、胸骨缺损横径,测量残留胸骨最下端至胸廓前壁正中膈肌水平的距离作为胸骨缺损纵径;计算胸骨缺损指数(sternal defect index,SDI),SDI=胸骨缺损横径×2/(胸骨缺损纵径+胸廓横径×0.2)。结果直接缝合组患儿一期手术时SDI值小于非直接缝合组,差异有统计学意义(P=0.003);两组手术年龄、体重、完全型Cantrell五联症占比及复杂心脏畸形占比差异均无统计学意义(P>0.05)。11例Cantrell五联症患儿中,2例于心脏手术后因心力衰竭死亡,其余9例随访6个月至10年,除1例尚未接受心脏根治手术外,其余患儿心脏功能良好,胸廓外观满意,生活质量良好。结论Cantrell五联症患儿的预后主要取决于心脏异位与心内畸形的严重程度。SDI作为一个创新指标,对手术策略的选择具有一定参考意义。对于1岁以内、SDI<1的患儿,可首先尝试直接缝合胸骨,如无法直接缝合,可使用人造材料重建胸骨。