cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2016-31-3-26-32cardiotomsk-224Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESМЕТОДЫ ОСТЕОСИНТЕЗА ГРУДИНЫ В ЛЕЧЕНИИ И ПРОФИЛАКТИКЕ ОСЛОЖНЕНИЙ СРЕДИННОЙ СТЕРНОТОМИИAPPROACHES TO STERNAL OSTEOSYNTHESIS IN POSTSTERNOTOMY COMPLICATIONS MANAGEMENTШведоваМ. В.ShvedovaM. V.

канд. мед. наук, врач-хирург клиники госпитальной хирургии;

младший научный сотрудник,

634028, г. Томск, пр. Ленина, 4

Tomsk

shvedovamv55@gmail.comАнфиногеноваЯ. Д.AnfinogenovaY.

профессор кафедры нормальной физиологии, 634012, г. Томск, ул. Киевская, 111а;

научный сотрудник;

докт. мед. наук, ведущий научный сотрудник отделения популяционной кардиологии с группой научно-медицинской информации, патентоведения и международных связей

Tomsk

ya@cardio-tomsk.ruДамбаевГ. Ц.DambaevG. Ts.

докт. мед. наук, профессор, член-корреспондент РАН, заведующий кафедрой госпитальной хирургии,

634028, г. Томск, пр. Ленина, 4

Tomsk

kaf.gosp.hirurg@ssmu.ruВусикА. Н.VusikA. N.

докт. мед. наук, профессор кафедры госпитальной хирургии,

634028, г. Томск, пр. Ленина, 4

Tomsk

Федеральное государственное бюджетное образовательное учреждение высшего образования “Сибирский государственный медицинский университет” Министерства здравоохранения Российской Федерации; Центр RASA в Томске, Федеральное государственное автономное образовательное учреждение высшего образования “Национальный исследовательский Томский политехнический университет”РоссияSiberian State Medical University; RASA Center in Tomsk, National Research Tomsk Polytechnic UniversityRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования “Сибирский государственный медицинский университет” Министерства здравоохранения Российской Федерации; Центр RASA в Томске, Федеральное государственное автономное образовательное учреждение высшего образования “Национальный исследовательский Томский политехнический университет”; Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияSiberian State Medical University; RASA Center in Tomsk, National Research Tomsk Polytechnic University; Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования “Сибирский государственный медицинский университет” Министерства здравоохранения Российской ФедерацииРоссияSiberian State Medical University, TomskRussian Federation2016051120163132632Copyright © Шведова М.В., Анфиногенова Я.Д., Дамбаев Г.Ц., Вусик А.Н., 20162016Шведова М.В., Анфиногенова Я.Д., Дамбаев Г.Ц., Вусик А.Н.Shvedova M.V., Anfinogenova Y., Dambaev G.T., Vusik A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/224

Несостоятельность шва грудины после срединной стернотомии – это тяжелое кардиохирургическое осложнение, которое может привести не только к дискомфорту и дыхательной дисфункции, но и способствовать развитию поверхностной и медиастинальной инфекции, в итоге оказывая существенное влияние на выживание пациентов. В качестве интраоперационных факторов риска развития несостоятельности швов грудины немаловажное значение имеют методики остеосинтеза грудины и тип используемого шовного материала. С целью улучшения биомеханики дыхания и повышения качества жизни больных с послеоперационной нестабильностью грудины в отсутствие инфекции, а также больным с послеоперационным стерномедиастинитом (СМ) как завершающий этап лечения после купирования инфекционного процесса целесообразным является выполнение остеосинтеза грудины. С этой целью применяются различные шовные и скрепляющие материалы: распространен шов грудины стальной проволокой или полиэфирным материалом, однако из-за значительных механических усилий, сопровождающих движения грудной клетки, шовный материал часто прорезает ткани, что приводит к каскаду осложнений и необходимости повторных операций. Поэтому в настоящее время продолжают разрабатываться новые подходы и устройства для восстановления целостности грудины. В данном обзоре рассмотрены существующие на сегодняшний день методы стернального остеосинтеза, используемые в лечении и профилактике развития ос ложнений срединной стернотомии.

Failure of sternal suture after median sternotomy is a severe cardiac surgery complication causing respiratory dysfunction and contributing to superficial and mediastinal infection affecting patients’ survival. Perioperative risk factors for sternal dehiscence include the approaches to sternal osteosynthesis and type of suture material. To improve respiratory biomechanics and quality of life in patients with postoperative sternal instability without infection as well as in patients with postoperative sterno mediastinitis, sternal osteosynthesis is a relevant final step of treatment after elimination of the infection. To achieve that, various suture and wound closure materials are used. Stainless steel wire or polyester material sternal sutures are common, but they are often cheese wire tissues due to chest motions leading to cascade of complications and requiring reoperations. Therefore, new approaches and systems for restoration of sternal integrity continue to be developed. This article reviews currently available sternal resynthesis methods used for treatment and prevention of sternal sternotomy complications.

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The authors declare that there are no conflicts of interest present.