Does Elective Sternal Plating Combined with Steel Wire Reduce Sternal Complication Rates in Patients with Obesity?

ABSTRACT Introduction: In this study, sternal complication rates of sternal closures with steel wire or steel wire combined with titanium plate in patients with obesity that underwent cardiac surgery were investigated. Methods: The data of 316 patients that underwent cardiac surgery between May 2018 and October 2021 were analyzed retrospectively; 124 patients withbody mass index (BMI) ≥ 30 kg/m2 were divided into group I, patients whose sternotomy was performed with steel wires, and group II, patients whose sternotomy was performed with steel wire combined with titanium plates. Results: A total of 124 patients with BMI ≥ 30 kg/m2 were divided into group I (n=88 [70.9%]) and group II (n=36 [29.1%]). The rate of male patients was found to be significantly higher in group I, whereas the rate of female patients was significantly higher in group II (P<0.001). BMI values were found to be low in group I and high in group II (P<0.001). The distribution of complications was different in the BMI ≥ 35.00-39.99 kg/m2 and ≥ 40 kg/m2 groups (P=0.003). Development of complications was found to be higher in patients with BMI ≥ 40 kg/m2. Sternal dehiscence was observed in two patients in group I, while no dehiscence was observed in group II. Conclusion: The lower incidence of complications and the absence of non-infectious sternal complications and sternal dehiscence in patients with BMI ≥ 35 kg/m2 that underwent steel wire combined titanium plate sternal closure strengthened the idea that plate-supported sternal closure can prevent sternal complications in high-risk patients.

摘要
引言：本研究旨在探究接受心脏手术的肥胖患者采用钢丝缝合胸骨，或钢丝联合钛板缝合胸骨的胸骨并发症发生率。
方法：回顾性分析2018年5月至2021年10月间316例接受心脏手术患者的临床资料；将其中体质量指数（body mass index, BMI）≥30 kg/m²的124例患者分为两组：组I为行钢丝胸骨切开缝合术患者，组II为行钢丝联合钛板胸骨切开缝合术患者。
结果：最终纳入BMI≥30 kg/m²的患者共124例，其中组I 88例（占比70.9%），组II 36例（占比29.1%）。组I男性患者占比显著高于组II，而组II女性患者占比显著更高（P<0.001）。组I患者BMI值更低，组II患者BMI值更高（P<0.001）。在BMI≥35.00~39.99 kg/m²及≥40 kg/m²亚组中，并发症分布存在显著差异（P=0.003）；BMI≥40 kg/m²患者的并发症发生率更高。组I中共2例患者出现胸骨裂开，组II未观察到胸骨裂开病例。
结论：对于BMI≥35 kg/m²的患者，采用钢丝联合钛板缝合胸骨的并发症发生率更低，且未出现非感染性胸骨并发症及胸骨裂开，该结果支持钢板辅助胸骨缝合可预防高危患者胸骨并发症的观点。