Sternotomi fiksasyon metodlarının karşılaştırılması: Sert-rijit fiksasyona karşı aşırı kuvvet karşısında esnekliği ayarlanabilen yarı-esnek fiksasyon: Deneysel biyomekanik çalışma

Abstract

Amaç: Monofilament paslanmaz çelik tel (TEL), multifilaman paslanmaz çelik halat (HALAT), polipropilen bant kelepçe (KELEPÇE) ve multifilaman elastan fiber (ELASTAN) sütürler, deneysel düzenekle in vitro olarak kemik hasarı, elastik modül, çekme dayanımı, uzama ve kopma parametreleriyle karşılaştırılmıştır.

Gereç ve Yöntem: Koyun göğüs kafesleri median sternotomiyle iki parçaya ayrıldı ve sonrasında ilgili kapama yöntemiyle bir araya getirildi. Bu haliyle deneysel düzeneğe sabitlenerek 100-800N çekme testine (Instron, USA) tabi tutuldu. İlk aşamada sütür parçaları teker teker, sonra halka yapılıp düğümlenerek ve son aşamada sütüre edilmiş koyun göğüs kafesi şekinde test edildi. Sternumun maksimum kuvvetteki ayrışma mesafesi, sütürün kopma ve uzaması, elastik-plastik faz seviyeleri ve akma noktaları her aşamada kaydedildi.

Bulgular:Sütür-kemik temas yüzeyi KELEPÇE’de (3.5 mm: en yüksek), ELASTAN’da (2 mm), HALAT’ta (1.1 mm), TEL’de (0.8 mm: en düşük) iken, kemik doku hasarı ELASTAN’da hiç olmadı, HALAT’ta %11, TEL’de %29 seviyesinde oldu, KELEPÇE grubunda ise kemik hasarı oluşacak kuvvete erişmeden kopma gözlendi. Sütürde uzamanın başladığı ortalama seviyeler ise TEL’de 210N (en dayanıksız), KELEPÇE’de 320N, HALAT’ta (800N: en dayanıklı) ve ELASTAN’da (800N: en dayanıklı) şeklinde izlendi.800N’luk anlık aşırı kuvvet oluşmasının simüleedildiğiya aşamada kemik veya sütür hasarı oluşmadan kemiğin bir arada kalabildiği tek yöntem ELASTAN oldu.

Sonuç: Deney sonuçlarımıza göre sütür temas alanı ile kemik hasarının ters korele olduğu ve polipropilen materyal dayanımının bu alanda dayanıksız olduğu görüldü. Daha önemli olarak rijit sabitleme yerine bizim geliştirdiğimiz, 800N’a kadar rijit, daha üstünde elastik özellik gösteren ELASTAN yönteminin, anlık aşırı kuvvet altında dehissens oluşsa bile yeniden anında sternumu eski konumuna getirerek başarı sağladığı gösterildi.

Keywords

• sternotomi,rijitfiksasyon,çelik kablo,çelik tel,polipropilen kelepçe,elastan

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