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

Yıl 2019, Cilt: 9 Sayı: 3, 262 - 268, 30.09.2019

Mehmet Kabalcı Nesimi Günal Ali Bolat Koray Dural Berkant Özpolat

https://doi.org/10.16899/jcm.609633

Öz

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.

Anahtar Kelimeler

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

Proje Numarası

2016/036

Kaynakça

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