開心術後胸骨閉鎖3方法の比較―11年間722例の検討

Comparison of Three Methods of Sternal Closure after Open Heart Surgery：Analysis of 722 Cases for 11 Years

開心術後の急性期合併症である術後出血，縦隔炎，遅延型心タンポナーデの発症には胸骨閉鎖方法の相違が影響する．本稿では，プレート（吸収性，非吸収性）による胸骨閉鎖が開心術後の胸骨関連合併症を減少することを明らかにした．

722 patients who returned to the intensive care unit （ICU） after completing the cardiac surgery and closing the median sternotomy from Jan 2010 to Feb 2021 at our hospital were divided into 3 groups according to the different sternal closures. Sternum was fixed with 6 wires alone in group A （n＝333）, with 2 absorbable plates and 6 wires in group B （n＝259） or with 3 titanium plates with 20 screws and 4 wires in group C （n＝130）. Background characteristics were not different between the 3 groups. Total number of 3 complications （postsurgical bleeding, mediastinitis and delayed cardiac tamponade） was significantly less in group B and C than group A. Among them postsurgical bleeding needed hemostasis surgery was significantly less in group C than in group A. Surgical nor hospital mortality were not significantly different in 3 groups. Postsurgical complications were significantly less when the sternum closure was fixed with plates （absorbable, not absorbable）.