The first clinical experience of using bone chips to promote sternum reossification after median sternotomy
https://doi.org/10.24884/0042-4625-2021-180-5-25-33
Abstract
The OBJECTIVE was to evaluate the first experience of using bone chips in sternum metallic osteosynthesis in terms of safety and clinical efficacy.
METHODS AND MATERIALS. 20 patients, 10 people in each group (11 men and 9 women; the average age in Group 1 was 74.2±5.3 years; in Group 2 – (72.4±6.7) years) were enrolled in the study. In accordance with the objective of the study, when suturing the sternum, bone-chip grafts were inserted into the spongy substance in Group 1 patients. Group 2 included patients who underwent surgical treatment according to the generally accepted standard protocol: bone wax was applied to the spongy bone tissue of the sternum.
RESULTS. The evaluation of sternum reossification was performed with spiral computed tomography. The initial state of the bone tissue was examined before the operation, in the early postoperative period (12 days) and in the midterm period – 12 months after the operation. The results were evaluated on a point scale: 0 points – sternal diastasis more than 3 mm, 12 points – complete sternal consolidation. In the early postoperative period, the degree of sternum fusion did not differ in both groups. (Group 1 – (3.5±0.7); Group 2 – (3.5±0.8) points). In the mid-term follow-up (12 months after), the degree of sternum fusion in patients of Group 1 was (11±0.7) points, which was almost two times higher than in patients of Group 2 – (5.6±3) points.
CONCLUSION. The use of Xeno-materials for bone grafting in patients at high risk of impaired reossification after median sternotomy is safe and effective.
About the Authors
M. S. KuznetsovRussian Federation
Kuznetsov Mikhail S., Cand. of Sci. (Med.), Senior Research Fellow of Cardiovascular Surgery Department, Research Institute of Cardiology
634012, Tomsk, Kievskaia str., 111a
Competing Interests:
The authors declare no conflict of interest.
V. V. Shipulin
Russian Federation
Shipulin Vladimir V., Junior Research Fellow of the
Laboratory of Radionuclide Research Methods, Research Institute of Cardiology
634012, Tomsk, Kievskaia str., 111a
Competing Interests:
The authors declare no conflict of interest.
E. V. Lelik
Russian Federation
Lelik Evgeniya V., Cardiologist of Cardiac Surgery Department № 1, Research Institute of Cardiology
634012, Tomsk, Kievskaia str., 111a
Competing Interests:
The authors declare no conflict of interest.
G. G. Nasrashvili
Russian Federation
Nasrashvili Georgy G., Cand. of Sci. (Med.),
Cardiovascular Surgeon of Cardiac Surgery Department № 1, Research Institute of Cardiology
634012, Tomsk, Kievskaia str., 111a
Competing Interests:
The authors declare no conflict of interest.
D. S. Panfilov
Russian Federation
Panfilov Dmitry S., Dr. of Sci. (Med.), Senior Research Fellow of Cardiovascular Surgery Department, Research Institute of Cardiology
634012, Tomsk, Kievskaia str., 111a
Competing Interests:
The authors declare no conflict of interest.
B. N. Kozlov
Russian Federation
Kozlov Boris N., Dr. of Sci. (Med.), Head of Cardiovascular Surgery Departments, Research Institute of Cardiology
634012, Tomsk, Kievskaia str., 111a
Competing Interests:
The authors declare no conflict of interest.
References
1. Balachandran S., Lee A., Denehy L. et al. Risk Factors For Sternal Complications After Cardiac Operations: A Systematic Review // Ann. Thorac. Surg. 2016;102(6):2109–2117. Doi: https://doi.org/10.1016/j.athoracsur.2016.05.047.
2. Shvedova M. V., Anfinogenova Y., Dambaev G. T., Vusik A. N. Approaches to sternal osteosynthesis in poststernotomy complications management // The Siberian Journal of Clinical and Experimental Medicine. 2016;31(3):26–32. (In Russ.). Doi: https://doi.org/10.29001/2073-8552-2016-31-3-26-32.
3. Charchyan E. R., Stepanenko A. В., Gens A. Р., Skvortsov А. А., Galeev N. А. The effect of the sternal closure techniques on pain severity after cardiac surgery // Clin. Experiment. Surg. Petrovsky J. 2016;4(3):65–73. (In Russ.).
4. Khubulava G. G., Shchikhverdiev N. N., Vogt P. R., Marchenko S. P., Naumov A. B., Suvorov V. V., Averkin I. I. Results of application of the method of sternal infection elimination in cardiosurgical patients // Grekov’s Bulletin of Surgery. 2015;174(5):57–60. (In Russ.). Doi: https://doi.org/10.24884/0042-4625-2015-174-5-57-60.
5. Kuznetsov M. S., Kozlov B. N., Nasrashvili G. G., Panfilov D. S., Andriyanova A. V., Petlin K. A., Shipulin V. M. Methods for elimination of sternal infections in cardiac surgery. Comparative analysis of the outcomes // Clin. Experiment. Surg. Petrovsky J. 2016;4(2):51–59. (In Russ.).
6. Mehaffey J. H., Hawkins R. B., Byler M., Charles E. J., Fonner C., Kron I., Quader M., Speir A., Rich J., Ailawadi G. Virginia Cardiac Services Quality Initiative. Cost of individual complications following coronary artery bypass grafting // J Thorac Cardiovasc Surg. 2018;155(3):875–882.e1. Doi:10.1016/j.jtcvs.2017.08.144. PMID:29248284.
7. van Wingerden J. J., de Mol B. A., van der Horst C. M. Defining poststernotomy mediastinitis for clinical evidence-based studies // Asian Cardiovascular and Thoracic Annals. 2016;24(4):355–363. Doi:10.1177/0218492316639405.
8. Reddy M. S. B., Ponnamma D., Choudhary R., Sadasivuni K. K. A Comparative Review of Natural and Synthetic Biopolymer Composite Scaffolds // Polymers. 2021;13(7):1105. Doi: https://doi.org/10.3390/polym13071105.
9. Moskvin G. V., Grebnev G. A., Chernegov V. V., Borodulina I. I., Slivkin A. A., Shcherbinina N. Yu. Application of bone-plastic operation methods upon maxillary atrophies // Institut Stomatologii. 2018;80(3):59–60. (In Russ.).
10. Shin Y. C., Kim S. H., Kim D. J., Kim D. J., Kim J. S., Lim C., Park K. H. Sternal healing after coronary artery bypass grafting using bilateral internal thoracic arteries: assessment by computed tomography scan // Korean J Thorac Cardiovasc Surg. 2015;48(1):33–39. Doi:10.5090/kjtcs.2015.48.1.33. PMID:25705595; PMCID: PMC4333848.
11. Charchian É. R., Stepanenko A. B., Gens A. P., Khovrin V. V., Kudryashov A. M., Galeev N. A., Belov Iu. V. Prospective randomized trial to compare various sternal closure techniques after cardiac surgery // Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2017;10(3):31–37. Doi: https://doi.org/10.17116/kardio201710331-37.
12. Herford A. S., Nguyen K. Complex bone augmentation in alveolar ridge defects // Oral Maxillofac Surg Clin North Am. 2015;(27):227–244. Doi:10.1016/j.coms.2015.01.003.
13. Kirmani B. H., Jones S. G., Datta S., Mclaughlin E. K., Hoschtitzky A. J. A meta-analysis of platelet gel for prevention of sternal wound infections following cardiac surgery // Blood Transfus. 2017;15(1):57–65. Doi:10.2450/2016.0231-15.
14. Azarova O. A., Azarova E. A., Kharitonov D. Yu., Podoprigora A. V., Shevchenko L. V. Mod¬ern aspects of application of osteoplastic materials in dental surgery // Belgorod State University Scientific Bulletin. Medicine. Pharmacy series. 2019;42(2):215–223. (In Russ.). Doi:10.18413/2075-4728-2019-42¬-2-215-223.
15. Stogov M. V., Smolentsev D. V., Kireeva E. A. Bone Xenografts in Trauma and Orthopaedics (Analytical Review) // Traumatology and Orthopedics of Russia. 2020;26(1):181–189. Doi:10.21823/2311-2905-2020-26-1-181-189.
Supplementary files
Review
For citations:
Kuznetsov M.S., Shipulin V.V., Lelik E.V., Nasrashvili G.G., Panfilov D.S., Kozlov B.N. The first clinical experience of using bone chips to promote sternum reossification after median sternotomy. Grekov's Bulletin of Surgery. 2021;180(5):25-33. (In Russ.) https://doi.org/10.24884/0042-4625-2021-180-5-25-33