波型生体吸収性プレートを併用した胸骨閉創の安全性・有用性

The Role of Corrugated Bioresorbable Sheet for Bone Fixation after Median Sternotomy

胸骨正中切開は，いまだ心臓血管外科手術の標準的到達法である．同切開に対する閉胸法は，術後出血量や胸骨離開，ひいては縦隔炎発症にも影響を与える．従来の金属ワイヤーのみによる固定は，左右胸骨のずれ，ワイヤー断裂，ワイヤーによる胸骨離断などにより，胸骨の固定性に問題を起こす場合があり，これまでも補強としてRobicsek 変法，生体吸収性骨接合用胸骨ピン・メッシュ型プレート・チタンプレートを併用して，胸骨動揺を軽減する試みが行われてきた1～6）．

Objectives：Performing sternal reconstruction after a median sternotomy using a corrugated bioresorbable sheet composed of poly-L-lactide acid and hydroxyapatite can improve the safety and efficacy of the treatment outcome and promote bone healing.

Methods：We compared treatment outcomes of 53 patients who underwent sternal closure using a corrugated sheet （group P） from October 2018 with retrospectively evaluated outcomes of 57 patients who underwent sternal closure using a sternal pin-type device （group C）.

Results：Sternal wound infection was not observed in either group. Significant sternal dehiscence was not observed in group P, but it was seen in three cases in group C （p＝0.0449）. Incomplete approximation by wire cutting was observed in 3％ of patients in group P and 15％ of patients in group C （p＝0.0645）. Displacement in the antero-posterior direction was 1.35 mm in group P and 1.67 mm in group C （p＝0.0707）. The drain discharge volume during 12 hours after operation was 175 ml for group P and 220 ml for group C （p＝0.1958）, while the total drain discharge volume was 380 ml for group P and 622 ml for group C （p＝0.0068）. The mean hospital stay was 23.9 days for group P and 26.3 days for group C （p＝0.3637）.

Conclusions：The total volume of drain discharge significantly decreased when a bioresorbable corrugated sheet was used for sternal closure. We also consider that the bioresorbable corrugated sheet may improve repair of the split sternum and could result in decreased sternal dehiscence.