CAJ | 학술논문

目的总结应用“骨骼化”乳内动脉获取技术结合钛板钉胸骨固定技术对高龄冠状动脉搭桥患者胸骨保护的经验。方法回顾分析70岁以上行冠状动脉搭桥术的患者202例，按照获取乳内动脉技术的不同分为研究组（骨骼化法）和对照组（传统带蒂法）。研究组：患者34例，男27例，女7例；9例患者以SternaLock钛板钉胸骨固定系统固定胸骨，其他25例采用钢丝环扎法固定胸骨。对照组：患者168例，男125例，女43例；全部采用钢丝环扎法固定胸骨。结果研究组无住院死亡，无胸骨愈合不良及相关并发症。对照组4例病死，10例胸骨愈合不良，其中1例并发纵隔感染而死亡。具有三项或以上胸骨愈合不良危险因素的患者，研究组与对照组比较胸骨愈合不良的发生率具有统计学差异［0（0/12）vs．29畅2％（7/24），P＝0畅04］。结论应用“骨骼化法”获取乳内动脉结合钛板钉胸骨固定系统技术，可使高龄冠状动脉搭桥患者受益。
목적총결응용“골격화”유내동맥획취기술결합태판정흉골고정기술대고령관상동맥탑교환자흉골보호적경험。방법회고분석70세이상행관상동맥탑교술적환자202례，안조획취유내동맥기술적불동분위연구조（골격화법）화대조조（전통대체법）。연구조：환자34례，남27례，녀7례；9례환자이SternaLock태판정흉골고정계통고정흉골，기타25례채용강사배찰법고정흉골。대조조：환자168례，남125례，녀43례；전부채용강사배찰법고정흉골。결과연구조무주원사망，무흉골유합불량급상관병발증。대조조4례병사，10례흉골유합불량，기중1례병발종격감염이사망。구유삼항혹이상흉골유합불량위험인소적환자，연구조여대조조비교흉골유합불량적발생솔구유통계학차이［0（0/12）vs．29창2％（7/24），P＝0창04］。결론응용“골격화법”획취유내동맥결합태판정흉골고정계통기술，가사고령관상동맥탑교환자수익。
Objective To describe and review our experiences in a new technique of skeletonized harvesting of the left internal mammary artery ( LIMA) combined with the use of titanium plate fixation for sternal closure in elderly patients undergoing coronary artery bypass grafting (CABG).Methods 202 elderly patients(age>70 years) undergoing CABG during January 2011 to June 2012 were divided into study group and control group retrospectively.Study group:Skeletonized LIMAs were harvested in all 34 cases,in which 27 patients were males and 7 patients were females .SternaLock titanium plate fixation was used to fix sternum in 9 high-risk patients . Control group:Traditional pedicled LIMA combined with cerclage fixation of the sternum was applied in 168 cases, in which 125 patients were males and 43 patients were females .Results In study group no patient died or complicated with sternal dehiscence .In control group,four patients died,in which one patient died of mediastinitis and three died of multiple organ dysfunction syndrome ( MODS) .Ten cases complicated with sternal dehiscence .The sternal complication rate of high-risk patients between these two groups had significant difference [ 0 ( 0/12 ) vs. 29.2%(7/24),P =0.04].Conclusion The technique of skeletonized harvesting of LIMA and titanium plate fixation for sternal closure benefits the elderly patients undergoing CABG .