The Thoracic and cardiovascular surgeon · 2012
Chronic poststernotomy pain after cardiac surgery: correlation of computed tomography findings on sternal healing with postoperative chest pain.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Papadopoulos Nestoras, Hacibaramoglu Meltem, Kati Canan, Muller Dominik, Flöter Julius, Moritz Anton
Аннотация
BACKGROUND: The aim of this study was to correlate CT findings on sternal healing to late postoperative chest pain after median sternotomy.
METHODS: 71 patients with a mean age of 69 ± 8.4 years were examined by CT-scan for normal or imperfect sternal healing at a mean follow-up time of 1.4 ± 1.6 years. Patients completed a questionnaire for chest and shoulder pain using a multidimensional pain score and visual analog scale.
RESULTS: Total 48 patients showed complete and 23 incomplete sternal healing. Although pain incidence was insignificantly higher after incomplete then after complete sternal healing (56.5% vs. 43%) pain intensity in the regions of chest and shoulder was almost equal between the two groups. Yet patients with a dehiscence over 3 mm in width had a significant higher chest pain intensity (17.5 ± 20 mm) compared with patients with a minor dehiscence (3.7 ± 8, mm p = 0.04) and those with normal sternal healing (8.1 ± 16 mm, p = 0.05). Furthermore, a dehiscence in more than one sternal segment led to a significantly higher pain intensity (chest: 18.8 ± 26 mm, shoulder: 23 ± 24 mm) compared with a dehiscence localized in only one segment (chest: 8.1 ± 18 mm, p = 0.04, shoulder: 4.6 ± 8.7 mm, p = 0.037).
CONCLUSION: In general, there is only a weak correlation between late postoperative chest pain and quality of sternal reunion. However, with an extent of failed sternal reunion over a width of 3 mm and the presence of imperfect ossification in more than one segment of the sternum, a significant increase of pain intensity in the regions of chest and shoulder was observed.
METHODS: 71 patients with a mean age of 69 ± 8.4 years were examined by CT-scan for normal or imperfect sternal healing at a mean follow-up time of 1.4 ± 1.6 years. Patients completed a questionnaire for chest and shoulder pain using a multidimensional pain score and visual analog scale.
RESULTS: Total 48 patients showed complete and 23 incomplete sternal healing. Although pain incidence was insignificantly higher after incomplete then after complete sternal healing (56.5% vs. 43%) pain intensity in the regions of chest and shoulder was almost equal between the two groups. Yet patients with a dehiscence over 3 mm in width had a significant higher chest pain intensity (17.5 ± 20 mm) compared with patients with a minor dehiscence (3.7 ± 8, mm p = 0.04) and those with normal sternal healing (8.1 ± 16 mm, p = 0.05). Furthermore, a dehiscence in more than one sternal segment led to a significantly higher pain intensity (chest: 18.8 ± 26 mm, shoulder: 23 ± 24 mm) compared with a dehiscence localized in only one segment (chest: 8.1 ± 18 mm, p = 0.04, shoulder: 4.6 ± 8.7 mm, p = 0.037).
CONCLUSION: In general, there is only a weak correlation between late postoperative chest pain and quality of sternal reunion. However, with an extent of failed sternal reunion over a width of 3 mm and the presence of imperfect ossification in more than one segment of the sternum, a significant increase of pain intensity in the regions of chest and shoulder was observed.