Abstract
The problem of sternal osteosynthesis after cardiac surgery is relevant because of a relatively high incidence of postoperative complications associated with inadequate sternal consolidation. The use of nitinol clips is one of the reliable and versatile methods of sternal osteosynthesis. Our research included 208 postoperative patients with different cardiac surgical pathologies. All interventions were carried out with cardiopulmonary bypass using median sternotomy. Patients were divided into 2 groups according to sternal fixation methods: group 1 (105 patients) - wire suture osteosynthesis, group 2 (103 patients) - nitinol clips closure. The short-term postoperative results were analyzed by using the major criteria for comparison. Radiographically confirmed varying degrees of sternal defects in the immediate postoperative period were observed in 15.2% of patients in group 1 and 3.8% of patients in group 2. In group 1 significant sternal defects requiring sternal refixation were observed in 4.8% of patients; in group 2 no such cases were identified. The mean blood loss in the drainages for 24 hours after surgery in group 1 was 351 65 ml; in group 2 - 192 43 ml. The total number of resternotomies for bleeding in group 1 was 6.7% of cases, with half of them being the patients with the source from the sternum in the site of wire sutures, while in group 2 4.9% patients underwent resternotomy, with no bleeding from the sites of clip fixation. Thus, the use of nitinol clips after longitudinal median sternotomy is a more reliable method of sternal osteosynthesis (as compared with the classical method), which enables us to minimize the risk of damage to the retrosternal structures, preserve sternal consolidation and reduce blood loss in the drainages in the early postoperative period.
Highlights
Важнейшую роль в профилактике раневых осложнений после срединной стернотомии играет правильная фиксация грудины после операции
Проблема остеосинтеза грудины после кардиохирургических операций актуальна из-за относительно высокой частоты послеоперационных осложнений
Tavlasoglu M., Kurkluoglu M., Arslan Z. et al // Interact
Summary
По данным J.F. Gummert и др., к послеоперационным факторам риска развития несостоятельности грудины относят: возраст старше 60 лет, избыточный вес, сахарный диабет, повторные операции с ИК, использование внутренней грудной артерии для реваскуляризации миокарда и т. Частота послеоперационной несостоятельности грудины после стандартной фиксации вследствие механических повреждений или инфицирования составляет от 0,5 до 8% [8]. Риск возникновения послеоперационных кровотечений составляет от 5 до 15%, причем при реторакотомии: из кондуита или места анастомоза – 38% случаев, из грудины и ложа внутренней грудной артерии – 32%, из мягких тканей – 14%, из места установки канюль – 16% наблюдений; в 34% случаев причина кровотечения остается не выявленной [9]. Цель исследования – оценка эффективности и безопасности применения нитиноловых скоб с саморегулирующейся компрессией для остеосинтеза грудины после операций на сердце и грудной аорте с использованием срединной стернотомии
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