Applying Modified Robicsek Chest Closure and Bilateral Pectoralis Major Muscle Flaps during Off-pump Coronary Artery Bypass Graft_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

宋偉 , 汪川 , 顧承雄

首都醫科大學附屬北京安貞醫院心臟外科（北京 100029）;

Corresponding?author：

Keywords：

胸骨; 改良Robicsek法; 胸大肌瓣; 并發癥

DOI：

10.7507/1007-4848.20150246

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目的通過改良Robicsek法胸骨固定及雙側胸大肌內側頭轉移在非體外循環冠狀動脈旁路移植術（OPCAB）患者胸骨固定中的應用，探討此技術在預防OPCAB術后胸骨并發癥的作用。方法回顧性分析2011年2月至2013年4月北京安貞醫院46例符合高危人群指征的心臟病患者行改良Robicsek法胸骨固定及雙側胸大肌內側頭轉移手術的臨床資料。男17例，女29例；年齡63～82（68.6±4.6）歲。結果 46例患者手術過程順利，無1例發生胸骨并發癥。1例死于圍手術期心肌梗死、左心力衰竭，其余患者術后肌瓣存活良好。45例術后14 d拆線，傷口愈合良好。所有患者出院后1個月、6個月進行隨訪，皮膚切口愈合良好，胸骨固定良好，無竇道形成，未見反常呼吸運動，胸廓外形良好。結論相對于傳統閉合切口的方法，對可能發生胸骨合并癥的高危人群，采用改良Robicsek法胸骨固定及雙側胸大肌內側頭轉移術有一定的優勢，能降低胸骨裂開及切口感染的概率，從而降低全身感染的概率，縮短患者康復時間，減輕心理壓力。

Citation： 宋偉, 汪川, 顧承雄. Applying Modified Robicsek Chest Closure and Bilateral Pectoralis Major Muscle Flaps during Off-pump Coronary Artery Bypass Graft. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(10): 989-991. doi: 10.7507/1007-4848.20150246 Copy

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2.	Saso S,James D,Vecht JA,et al.Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection.Ann Thorac Surg,2010,89(2):661-670.
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4.	孫廣龍,曹向戎,張健群.雙側胸大肌內側頭轉移術治療心臟術后胸骨哆開.中國胸心血管外科臨床雜志,2013,20(2):185-187.
5.	鄭慶林,薄學榮,索峰,等.冠狀動脈搭橋術移植材料的選擇.中國心血管病研究雜志,2005,3(11):41-42.
6.	De Feo M,Vicchio M,Nappi G,et al.Role of vacuum in methicillinresistant deep sternal wound infection.Asian Cardiovasc Thorac Ann,2010,18(4):360-363.
7.	趙子牛,程兆云,王圣,等.冠狀動脈搭橋術后胸骨哆開的原因分析與診治.武漢大學學報:醫學版,2012,33(6):909-911.
8.	Pai S,Gunja NJ,Dupak EL.In vitro comparison of wire and plate fixation for midline sternotomies.Ann Thorac Surg,2005,80(3):962-968.
9.	徐勇,李明秋,榮曉松.心臟手術胸骨固定的方法與進展.中國社區醫師:醫學專業,2012,14(23):21-22.
10.	Kamiya H,Al-maisary SS,Akhyari P,et al.The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients.Interact Cardiovasc Thorac Surg,2012,15(4):665-670.
11.	朱敬民,郝天智,賀立新,等.經胸骨正中手術切口感染創面的修復.中國修復重建外科雜志,2007,21(12):1323-1325.
12.	De Brabandere K,Jacobs-Tulleneers-Thevissen D,Czapla J,et al.Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy.Tex Heart Inst J,2012,39(3):367-371.
13.	Bhattacharya S,Sau I,Mohan M,et al.Sternal bands for closure of midline sternotomy leads to better wound healing.Asian Cardiovasc Thorac Ann,2007,15(1):59-63.
14.	Fleck T,Fleck M.Negative pressure wound therapy for the treatment of sternal wound infections after cardiac surgery.Int Wound J,2012.[Epub ahead of print].
15.	林宇,黃心潔,王侃,等.胸骨鈦板內固定技術在心臟手術患者胸骨固定中的應用.廣東醫學,2013,34(11):1727-1728.

1. 張柯,黃建宇,張根亭,等.冠心病搭橋術后胸骨裂開的防治.河南外科學雜志,2001,7(1):53-54.
2. Saso S,James D,Vecht JA,et al.Effect of skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection.Ann Thorac Surg,2010,89(2):661-670.
3. Ridderstolpe L,Gill H,Granfeldt H,et al.Superficial and deep sternal wound complications;incidence,risk factors and mortality.Eur J Cardiothorac Surg,2001,20(6):1168-1175.
4. 孫廣龍,曹向戎,張健群.雙側胸大肌內側頭轉移術治療心臟術后胸骨哆開.中國胸心血管外科臨床雜志,2013,20(2):185-187.
5. 鄭慶林,薄學榮,索峰,等.冠狀動脈搭橋術移植材料的選擇.中國心血管病研究雜志,2005,3(11):41-42.
6. De Feo M,Vicchio M,Nappi G,et al.Role of vacuum in methicillinresistant deep sternal wound infection.Asian Cardiovasc Thorac Ann,2010,18(4):360-363.
7. 趙子牛,程兆云,王圣,等.冠狀動脈搭橋術后胸骨哆開的原因分析與診治.武漢大學學報:醫學版,2012,33(6):909-911.
8. Pai S,Gunja NJ,Dupak EL.In vitro comparison of wire and plate fixation for midline sternotomies.Ann Thorac Surg,2005,80(3):962-968.
9. 徐勇,李明秋,榮曉松.心臟手術胸骨固定的方法與進展.中國社區醫師:醫學專業,2012,14(23):21-22.
10. Kamiya H,Al-maisary SS,Akhyari P,et al.The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients.Interact Cardiovasc Thorac Surg,2012,15(4):665-670.
11. 朱敬民,郝天智,賀立新,等.經胸骨正中手術切口感染創面的修復.中國修復重建外科雜志,2007,21(12):1323-1325.
12. De Brabandere K,Jacobs-Tulleneers-Thevissen D,Czapla J,et al.Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy.Tex Heart Inst J,2012,39(3):367-371.
13. Bhattacharya S,Sau I,Mohan M,et al.Sternal bands for closure of midline sternotomy leads to better wound healing.Asian Cardiovasc Thorac Ann,2007,15(1):59-63.
14. Fleck T,Fleck M.Negative pressure wound therapy for the treatment of sternal wound infections after cardiac surgery.Int Wound J,2012.[Epub ahead of print].
15. 林宇,黃心潔,王侃,等.胸骨鈦板內固定技術在心臟手術患者胸骨固定中的應用.廣東醫學,2013,34(11):1727-1728.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Applying Modified Robicsek Chest Closure and Bilateral Pectoralis Major Muscle Flaps during Off-pump Coronary Artery Bypass Graft

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