Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system
Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system
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DOI：
10.21037/jtd.2016.02.64
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发表时间：
2016-03-01
影响因子：
2.5
通讯作者：
Loizzi, Michele
中科院分区：
文献类型：
--
作者：
De Palma, Angela;Sollitto, Francesco;Loizzi, Michele
背景资料：我们报告了5年前引入的用于胸壁稳定和重建的专用Synthes（R）钛板系统的短期和长期结果。（2010年1月至2014年12月）27例连续患者（22名男性，5名女性;范围16-83岁，中位年龄60岁），使用该系统治疗：原发性[3]和继发性[8]胸壁肿瘤;连枷胸[5];多根肋骨骨折[5];胸骨裂开-胸骨脱位[3];胸骨骨折[1];胸锁关节脱位[1];波兰综合征[1]。短期结果评价为：手术时间、术后发病率、死亡率、住院时间;长期结果评价为：生存率、平板相关发病率、肺功能测定值、胸痛[用语言评定量表（VRS）和SF 12标准V1问卷测量]。（中位数2）钛板/夹板;中位手术时间为150 min（范围：115-430 min）。术后病程：15例患者（55.6%）顺利，10例（37%）轻微并发症，2例（7.4%）严重并发症;无术后死亡。中位术后住院时间为13天（范围：5-129天）。中位随访时间为20个月（范围：1-59个月），21例患者（78%）存活，6例（22%）死亡。3例患者出现长期接骨板相关发病：接骨板断裂[2]、钉板脱位[1]; 2例需要二次手术探查。术后1年的中位肺量测定值为：FVC 3.31 L（90%），FEV 1 2.46 L（78%），DLCO 20.9 mL/mmHg/min（76%）。在21例存活患者中，7例（33.3%）报告无疼痛（VRS评分0），10（47.6%）轻度（2分），4（19.1%）中度（评分4），无重度（评分> 4）; 15（71.5%）报告无或轻度，6（28.5%）中度疼痛影响生活质量。使用Synthes（R）钛板系统实现了最佳的胸壁稳定和重建，发病率最低，无术后死亡，可接受的手术时间和术后住院时间。实现了正常呼吸功能的长期恢复，具有最小的板相关发病率和胸痛。
Background: We report short and long-term results with the dedicated Synthes (R) titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction.Methods: We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16-83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire].Results: Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115-430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5-129 days). At a median follow-up of 20 months (range: 1-59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score > 4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life.Conclusions: An optimal chest wall stabilization and reconstruction was achieved with the Synthes (R) titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time and post-operative hospital stay. Long-term restoration of a normal respiratory function was achieved, with minimal plates-related morbidity and chest pain.