胸骨上举术的固定方式与结果

LongTerm Results of Sternal Elevation for Pectus Excavatum.

目的：分析胸骨上举术的不同固定方式与手术效果的关系。方法：１４８例经胸骨上举术治疗的漏斗胸患儿，术中分别用自制金属支杠、三点式悬吊和塑料及金属制成的支架背心悬吊固定胸骨。结果：其中８４例患儿获术后６个月至６年（平均２年）随访观察，绝大部分效果满意，仅２例复发。２７例保留金属支杠于术后１０～１２个月拔除者，无复发，外观更满意。结论：胸骨上举术治疗漏斗胸的效果肯定，手术安全。用自制金属支杠固定上举的胸骨操作简便，术后护理方便。保持金属支杠于手术后１０～１２个月才拔除，有利于防止复发，胸廓外形更满意。三点式悬吊固定对较小的轻度患儿适用。支架背心悬吊固定法术后护理不便，影响患儿日常生活。

Objective: To compare the results of sternal elevation for pectus excavatum with different fixation techniques.Methods: From 1986 to 1996, 148 children underwent sternal elevation with different fixation procedures including metal struts, tripods and metal or plastic frames. Results: 84 patients were followedup for 6 months to 6 years. The majority of patients had satisfactory results except 2 recurrences. Twentyseven patients had the removal of struts 10～12 months postoperatively with better cosmetic appearance. Conclusions: Sternal elevation with various internal fixation is an effective and safe procedure for pectus excavatum. Metal struts are easy to handle and care after operation. Removal of struts 10～12 months postoperatively may prevent recurrence and result in better cosmetic appearance. Tripod is more sutiable for younger children with milder deformities. Fixation with frame is of limited value since it is inconvenient and interferes with patients' daily activities postoperatively.