Corpus Sterni Reinforcement Improves the Stability of Primary Sternal Closure in High-Risk Patients

Purpose To compare standard sternal closure techniques with reinforcement longitudinal wire placement in the corpus sterni in high-risk patients undergoing open-heart surgery via median sternotomy. Methods The subjects of this study were 71 high-risk patients, 32 (45%) of whom underwent sternal closure by conventional methods (group 1) and 39 (55%) of whom underwent sternal closure with corpus sterni reinforcement. The patients were followed up for a mean period of 90 days. Results In group 2, none of the patients had sternal dehiscence and no revision was required, but in group 1, five (15.5%) patients had sternal dehiscence. This difference was significant between the groups (P = 0.024), but there were no significant differences in mediastinitis and mortality (P > 0.05). Conclusions Our findings suggest that primary sternal closure with longitudinal wire reinforcement on both sides of the corpus sterni will decrease the risk of infection and improve wound-healing in parallel with a decrease in sternal dehiscence.     

经胸骨柄“U”形开窗入路显露上胸椎的应用解剖

目的：研究经胸骨柄“U”形切除入路显露上胸椎的可行性。方法：观测35具经甲醛固定的尸体标本上胸椎（T1-4）椎体宽（a）／胸骨柄最窄处宽（b）（a／b）；在50例脊柱颈胸段MRI片上，测量T4椎体下缘在胸骨柄上水平投影点至颈静脉切迹中点的距离（C）／胸骨柄长（d）（c／d）。尸体标本上模拟手术入路操作。结果：a／b均值为78％±7．9％，c／d均值为72％±14．7％，a／b、c／d均〈1。经胸骨柄“U”形开窗可显露T4椎体，尸体标本上模拟手术操作，能在直视下完成T1及以上椎体的手术操作。结论：经胸骨柄“U”形开窗可显露T4椎体并能充分满足T3及以上椎体前路手术操作要求。     

Histiocytosis X: Solitary localization in the sternum of a 2-year-old child

In a 2-year-old child with a swelling of the soft tissues at the level of the manubrium sterni the X-ray examination showed a bone defect. There were no other bone defects in the rest of the skeleton. The biopsy showed that the changes in the bone and the soft tissues were caused by histiocytosis X in an apparently unique location.