微创矫治漏斗胸后时间延展胸廓骨重塑的临床研究

Clinical study of thoracic bone remodeling with time length after minimal-invasive repair for pectus excavatum

目的探讨漏斗胸微创矫治后时间延展性胸廓骨自身重塑的变化与临床疗效。方法 34例漏斗胸患者,其中男性27例,女性7例;年龄11～39岁,平均年龄18.1岁。组1为大龄儿童组,年龄11～17岁,13例;其中对称型(Ⅰ型)9例,非对称型(Ⅱ型)4例;漏斗胸指数(HI)3.2～4.6。组2为成人组,年龄18～39岁,21例;其中Ⅰ型10例,Ⅱ型11例;HI3.2～5.7。全身麻醉下在两侧腋中线切口,胸腔镜辅助先将扩展钳穿过胸骨形成隧道,抬举扩展钳重塑胸廓成形后,再将制备好的支撑杆置入胸骨后翻转至弓背向前固定。术前和术后胸部CT扫描,胸廓三维重建,矢状位测量胸骨与胸椎体前缘的距离。并观察心脏位置和胸廓外形。结果组1置入1杆10例,2杆3例;组2置入1杆12例,2杆9例。2组中矫形前、术后7 d比较,置入1根矫形板胸骨体下端均向前移位,而胸骨柄和胸骨体上端则反向移位;90 d时胸骨柄、体再缓慢向前移位。组2置入2根矫形板时,术后7 d和90 d胸骨柄体连续向前移位;90 d时胸廓外形饱满,心脏移位恢复正常。结论漏斗胸微创矫形后胸廓骨具有自行重塑的功能,用1根矫形板比2根者胸廓骨自行重塑更明显。

Objective To study the length of time and clinic effect of thoracic bone self remodeling after minimal-invasive correction for pectus excavatum（PE）.Methods A total of 34 patients were enrolled,male 27 and female 7,aged 11-39 years old,mean age 18.1 years old.Patients were assigned into 2 groups.Group 1 was older children group which included 13 cases aged 11-17 years old,9 with symmetry PE（type Ⅰ） and 4 with non-symmetry（type Ⅱ）;the Haller index（HI） were 3.2-4.6.Group 2 was adults group included 21 cases aged 18-39 years old,10 with symmetry PE（type Ⅰ） and 11 with non-symmetry（type Ⅱ）;HI were 3.2-5.7.Under general anesthesia,two incisions were made on both sides of the midaxillary line.Guided by the introducer and video-assistant thoracoscopic monitor,the substernal tunnel was then created and the depressed sternum was elevated,the thoracic bone remodeling was made by inserting the bar into retrosternumand rotated its convex forward.Single-bar was inserted for 10 and 12 patients in group 1 and 2,respectively;Double-bar was used for 3 and 9 patients in group 1 and 2,respectively.All patients were checked using chest CT scan and 3D reconstruction pre-operatively and on 7-and 90-day after operation.The sagittal view of the center line of thoracic vertebral body and the distance between sternum and frontal edge of thoracic vertebral body were measured.The position of heart and thorax shape were observed.Results Patients＇ results at pre-and 7-day of post-correction were compared.Among all patients treated with single-bar,the lower sternum moved forward,but manubrium and the upper sternum moved backwards from the central line.The results at 90-day post-correction showed that the manubrium and midsternum remained forward along the horary extension among patients who had double-bar treatment,the sternum moved forward persistently at 7-day and 90-day post-correction.The cardiac positions and chest shapes of 34 patients returned to normal.Conclusion It is demonstrated that thoracic bone possesses self remodeling ability after minimally-invasive correction of PE.The results showed thoracic bones self remodeling is better using single-bar than using double-bar.