基于胸壁压力值的鸡胸微创胸骨沉降术支架固定方式的初步探讨

Preliminary investigation of bar fixation for mini-invasive sternotomy for pectus carinatum based upon measurements of chest wall pressure

目的通过胸肋骨压力器测量鸡胸患儿前胸壁下压至正常所需压力值,探讨三种固定方式在鸡胸微创胸骨沉降术中的应用效果。方法本研究为回顾性研究,以2012年7月至2016年7月于首都医科大学附属北京儿童医院胸外科行鸡胸微创胸骨沉降术的144例患儿为研究对象,于手术前行胸壁测压,根据压力值及鸡胸形态分型拟定支架固定方式:A为双侧钢丝固定;B为双侧固定片固定;C为一侧钢丝一侧固定片固定。对于对称型鸡胸中压力值<10 kg者采取A固定,>10 kg者采取C固定;对于不对称型鸡胸中压力值<7.5 kg者采取A固定,7.5~10 kg者采取B固定,>10 kg者采取C固定;总结并分析不同固定方式患儿的一般资料、手术效果及并发症情况。结果144例患儿均顺利完成手术,无一例出现术中并发症。术后并发症包括气胸和钢丝断裂,其中气胸4例,均自行吸收;钢丝断裂共53例(53/144,36.81%),以A固定方式钢丝断裂发生率最高,占50.00%(40/80),B及C固定方式分别为13.64%(3/22)和23.81%(10/42)。由于胸壁外观均未受影响,断裂钢丝均于取支架时同期取出,无一例钢丝残留。取出支架后评估手术效果,三种固定方式优良率均为100%,无一例复发。结论基于胸壁压力值制定鸡胸微创胸骨沉降术固定方式,可简化手术操作,减少术中胸壁的操作性损伤,手术切口更小,外型更美观,值得临床推广。

Objective To explore the outcomes of three different fixation methods during mini-invasive sternotomy for pectus carinatum(PC)based upon sternal manometric measurements of pressure value after depressing anterior chest wall to normal in PC patients.Methods Chest wall pressure values were measured preoperatively in 144 children undergoing mini-invasive sternotomy from July 2012 to July 2016.The selection criteria for bar fixation were formulated according to pressure values and morphological typing of sternotomy.According to specific fixation methods,they were divided into three types of A(bilateral wire),B(bilateral stabilizer)and C(unilateral wire plus unilateral stabilizer).In symmetric type,fixation was performed when pressure value fell under 10 kg;C fixation when it surpassed 10 kg;in asymmetric type,fixation when pressure value dropped below 7.5 kg;B fixation when it was>7.5 kg and yet<10 kg;C fixation when it rose above 10 kg.General profiles,therapeutic outcomes and complications of three groups were summarized.Results All of them completed operations successfully without intraoperative complications,Postoperative complications included pneumothorax(n=4)and wire fracture(n=53).Four cases of minimal pneumothorax were self-absorbed.There were 53 cases of wire fracture(36.81%).The rate of wire fracture at 50%was the highest in A fixation method.Since the appearance of chest wall was not affected,fractured wire was removed at the same time during stent removal.The surgical outcomes were evaluated after bar removal.The excellent rate was 100%without recurrence.Conclusion Formulating preliminary selection criteria for fixation method of mini-invasive sternotomy based upon measurements of chest wall pressure may simplify surgical operations,minimize intraoperative chest wall injury and yield smaller and more aesthetic wounds.Clinical popularization is worthwhile.