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中华胸部外科电子杂志 ›› 2016, Vol. 03 ›› Issue (04) : 224 -227. doi: 10.3877/cma.j.issn.2095-8773.2016.04.07

所属专题: 文献

论著

自体肋骨移植在胸骨缺损重建中的应用
柴㼆1,(), 沈钢1, 张国飞1, 李文善1   
  1. 1. 310009 杭州,浙江大学医学院附属第二医院胸外科
  • 收稿日期:2016-05-30 出版日期:2016-11-28
  • 通信作者: 柴?

Application of autogenous rib graft in reconstruction of sternal defects

Ying Chai1,(), Gang Shen1, Guofei Zhang1, Wenshan Li1   

  1. 1. Department of Thoracic Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009 , China
  • Received:2016-05-30 Published:2016-11-28
  • Corresponding author: Ying Chai
  • About author:
    Corresponding author: Chai Ying, Email:
引用本文:

柴㼆, 沈钢, 张国飞, 李文善. 自体肋骨移植在胸骨缺损重建中的应用[J]. 中华胸部外科电子杂志, 2016, 03(04): 224-227.

Ying Chai, Gang Shen, Guofei Zhang, Wenshan Li. Application of autogenous rib graft in reconstruction of sternal defects[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(04): 224-227.

目的

探讨自体肋骨移植方式在胸骨缺损重建过程中的应用。

方法

回顾性分析浙江大学附属第二医院自2003年3月至2014年3月期间13例行胸骨切除,并使用自体肋骨移植方式重建胸骨缺损患者的病例资料。

结果

13例患者中,胸骨柄患者9例,胸骨体患者4例。术后病理证实:软骨肉瘤3例,骨髓炎3例,骨软骨瘤3例,淋巴瘤2例,骨巨细胞瘤1例,韧带样瘤1例。所有患者平稳度过围手术期。在长期随诊过程中,共有2例患者死亡,其中1例患者因非霍奇金淋巴瘤复发在术后6个月去世,另1例患者因心脏病在术后26个月去世;其余患者均胸廓塑形良好,未出现反常呼吸、外观畸形和胸廓不稳等情况。

结论

对于胸骨切除术后缺损的患者,建议使用自体肋骨移植的方式来重建缺损区域。

Objective

To investigate the application of autogenous rib graft in reconstruction of sternal defects.

Methods

The clinical data of 13 patients undergoing sternal resection and repair of defects with autogenous rib from March 2003 to March 2014 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed.

Results

There were 9 patients with manubrium lesions and 4 patients with mesosternum lesions. The postoperative pathology confirmed there were 3 cases of chondrosarcoma, 3 cases of osteomyelitis, 3 cases of osteochondroma, 2 cases of lymphoma, 1 case of osteoclastoma and 1 case of desmoid tumor. All patients recovered well during perioperation. In the long-term follow-up, one patient with non-Hodgkin lymphoma died as a result of local recurrence 6 months after surgery, and another one died of cardiac disease 26 months after surgery. There was no chest deformity, abnormal respiration or thoracic instability among the remaining patients.

Conclusions

Autogenous rib graft may be a safe and effective way in the reconstruction of sternal defects after resection.

图1 胸骨缺损相对不大,予以"‖"型纵向放置重建胸骨连续性。A:术中并列放置的自体肋骨以"‖"型固定于胸骨柄区域;B:术后胸骨重建CT影像,可见"‖"型放置固定良好的自体肋骨
图2 胸骨缺损稍大,以"T"字形放置于缺损区域。A:术中钢丝固定成型的自体肋骨以"T"字形固定于胸骨柄区域;B:术后胸骨重建CT影像,可见"T"型放置固定良好的自体肋骨
图3 胸骨缺损较大,术中将两侧第一胸锁关节均离断,并切除部分胸骨体,故以"∩"型方式重建,两侧锁骨断端之间以一小段肋骨相连,两侧锁骨断端至胸骨残端以肋骨固定。A:术前病变CT表现;B:术中成型方式;C:术后重建影像
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