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：

宋伟 , 汪川 , 顾承雄

首都医科大学附属北京安贞医院心脏外科（北京 100029）;

Corresponding author：

Keywords：

胸骨; 改良Robicsek法; 胸大肌瓣; 并发症

DOI：

10.7507/1007-4848.20150246

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目的通过改良Robicsek法胸骨固定及双侧胸大肌内侧头转移在非体外循环冠状动脉旁路移植术（OPCAB）患者胸骨固定中的应用，探讨此技术在预防OPCAB术后胸骨并发症的作用。方法回顾性分析2011年2月至2013年4月北京安贞医院46例符合高危人群指征的心脏病患者行改良Robicsek法胸骨固定及双侧胸大肌内侧头转移手术的临床资料。男17例，女29例；年龄63～82（68.6±4.6）岁。结果 46例患者手术过程顺利，无1例发生胸骨并发症。1例死于围手术期心肌梗死、左心力衰竭，其余患者术后肌瓣存活良好。45例术后14 d拆线，伤口愈合良好。所有患者出院后1个月、6个月进行随访，皮肤切口愈合良好，胸骨固定良好，无窦道形成，未见反常呼吸运动，胸廓外形良好。结论相对于传统闭合切口的方法，对可能发生胸骨合并症的高危人群，采用改良Robicsek法胸骨固定及双侧胸大肌内侧头转移术有一定的优势，能降低胸骨裂开及切口感染的概率，从而降低全身感染的概率，缩短患者康复时间，减轻心理压力。

Citation： 宋伟, 汪川, 顾承雄. 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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5.	郑庆林,薄学荣,索峰,等.冠状动脉搭桥术移植材料的选择.中国心血管病研究杂志,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.	赵子牛,程兆云,王圣,等.冠状动脉搭桥术后胸骨哆开的原因分析与诊治.武汉大学学报:医学版,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,荣晓松.心脏手术胸骨固定的方法与进展.中国社区医师:医学专业,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,贺立新,等.经胸骨正中手术切口感染创面的修复.中国修复重建外科杂志,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,黄心洁,王侃,等.胸骨钛板内固定技术在心脏手术患者胸骨固定中的应用.广东医学,2013,34(11):1727-1728.

1. 张柯,黄建宇,张根亭,等.冠心病搭桥术后胸骨裂开的防治.河南外科学杂志,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. 孙广龙,曹向戎,张健群.双侧胸大肌内侧头转移术治疗心脏术后胸骨哆开.中国胸心血管外科临床杂志,2013,20(2):185-187.
5. 郑庆林,薄学荣,索峰,等.冠状动脉搭桥术移植材料的选择.中国心血管病研究杂志,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. 赵子牛,程兆云,王圣,等.冠状动脉搭桥术后胸骨哆开的原因分析与诊治.武汉大学学报:医学版,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,荣晓松.心脏手术胸骨固定的方法与进展.中国社区医师:医学专业,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,贺立新,等.经胸骨正中手术切口感染创面的修复.中国修复重建外科杂志,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,黄心洁,王侃,等.胸骨钛板内固定技术在心脏手术患者胸骨固定中的应用.广东医学,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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