Clinical effect of new sternum embracing fixator combined with wire to fix sternum

Abstract

Objective To investigate the effect of a new sternum embracing fixator combined with wire to fixed sternum in the direct incision surgery of the adult heart. Methods A retrospective analysis was performed on 328 patients with cardiac vascular disease who underwent surgical treatment in the Department of Cardiovascular Surgery, Linyi People′s Hospital from January 2016 to December 2017. Based on the sternal fixation methods, those patients were divided into two groups: control group 159 cases and study group 169 cases. The control group used traditional steel wire to suture the left and right sides of the sawed sternum, and then tightened the steel wire, closed the sternum and tightened the steel wire to fix the sternum; the study group used wire-pair saw to open the sternum and placed a new embracing fixator to fix the sternum. The time of chest closure (the time from the beginning of the chest to the end of the skin incision suture), the rate of secondary thoracotomy (sternal correlation), the drainage at 24 h after surgery, the postoperative incision, sternum infection or sternal rupture rate, and postoperative chest pain or discomfort rate and postoperative hospital stay were analyzed. After the patients discharged from the hospital, follow-up was conducted through outpatient and telephone inquiries. Data were analyzed by t test and chi-square test. Results After the operation of the chest, one patient in the control group died of acute renal failure after acute type A aortic dissection, and all the other patients were cured and discharged. The time of chest closure in the study group was (32.3±7.3) min, which was significantly lower than that in the control group (51.5±8.4) min, the difference was statistically significant (t=-22.113, P<0.05). Sternal related secondary thoracotomy for hemostasis occurred in 1 case in the study group and 6 cases in the control group, the difference between the two groups was statistically significant (χ2=3.969, P=0.046). The drainage volume of the study group was (372.8±213.1) mL at 24 h after operation, which was less than that of the control group (538.9±202.6) mL, the difference was statistically significant (t=-7.224, P<0.05). There were no infection and(or) rupture of the incision and sternum in the study group. In the control group, there were 7 cases of infection and(or) rupture, including 4 cases of sternal rupture, the new circumcision was used to re-fix the sternum and all the 4 patients were cured; 2 cases of wound infection were treated with re-surgery and incision after dressing change; sternal infection in 1 case, the sternal debridement and pectoralis major muscle flap transfer were performed and the patients were discharged from the hospital. The difference between the two groups was statistically significant (χ2=7.599, P<0.05). There were 2 cases of chest pain discomfort in the study group, and 7 cases in the control group, the difference was statistically significant (χ2=4.101, P=0.043). The postoperative hospital stay in the study group was (8.6±4.1) d, which was lower than than the control group (10.5±3.4) d, the difference was statistically significant (t=-4.467, P<0.05). Patients were followed up (11.3±4.9) months after discharge, and all patients had no sternal infection and rupture. Conclusions The new sternum embracing device combined with wire-fixed sternal incision is simple and stable compared with traditional surgery. It has obvious advantages in shortening the time of chest surgery, preventing and reducing postoperative incision complications, and shortening hospital stay. It can be widely used in midline surgical incision in adult cardiac surgery. Key words: Surgical fixation devices; Sternum; Cardiovascular surgical procedures; Surgical wound dehiscence