成人漏斗胸微创矫治后胸廓骨重塑与临床疗效观察

Thoracic bone remodeling after minimally invasive repair for pectus excavatum in adults and its clinical efficacy

目的探讨成人漏斗胸微创矫形后胸廓骨的重塑变化与临床疗效。方法选择漏斗胸患者82例,男67例,女15例,年龄18～57(23.5±6.1)岁,对称型(Ⅰ型)37例,非对称型(Ⅱ型)45例,漏斗胸指数(HI)3.2～11.8(3.98±2.96)。所有患者均在全麻下行两侧腋中线切口,胸腔镜监视下将制备好的支撑杆置入胸骨后(1根60例,2根22例)。术前和术后1周行胸部CT扫描三维重建胸廓影像,在矢状位上以胸椎体中心线为切线位,测量胸骨与胸椎体前缘之间的距离,并观察心脏移位情况。结果使用1根矫形杆矫形后胸骨体中部及下端分别前移8.69、15.69mm,与术前比较差异有统计学意义(P<0.01),而胸骨体上端及胸骨柄上、下端分别前移2.39、-2.38、1.44mm,与术前比较差异无统计学意义。使用2根矫形杆矫形后胸骨柄下端及胸骨体上端、中部、下端分别前移10.8、12.45、17.61、20.62mm,与术前比较差异有统计学意义(P<0.01),而胸骨柄上端前移2.34mm,与术前比较差异无统计学意义。CT扫描显示矫形后心脏恢复正常位置。使用2根矫形杆者胸廓外观优于使用1根者。结论微创矫治成人漏斗胸时矫形杆的支撑力可使胸骨重塑成形;使用1根或2根矫形杆时胸骨的重塑变化规律及力学作用不同。

Objective To study thoracic bone remodeling after minimally invasive corrective surgery for pectus excavatum（PE） in adults and ascertain its clinical efficacy.Methods A total of 82 patients aged 18 to 57（23.5±6.1） were enrolled in this study.There were 67 male patients and 15 female patients.The symmetric type（Ⅰ type） composed of 37 cases,whereas the nonsymmetric type（Ⅱ type） comprised 45 cases.Haller index（HI） was 3.2 to 11.8.Under general anesthesia,incisions located on looth sides of the mid-axillary line were made in all patients.The prepared supporting bar was inserted behind the sternum by video-assisted thoracoscopic monitoring（one bar for 60 patients and two bars for 22 patients）.All patients were checked by chest CT scan pre-operation and 1 week post-operation to create a three-dimensional reconstruction thoracic image.In the sagittal plane,the center line of the body of the thoracic vertebrae was regarded as the incision line.The distance was measured between the sternum and the frontal edge of the body of the thoracic vertebrae.The condition of the displacement of the heart was also observed.Results When one bar was used,the middle and the inferior extremity of the mid-sternum was moved forward for 8.69 and 15.69mm,respectively,after correction.There was significant difference compared with that of the pre-operation（P0.01）.However,the upper extremity of the mid-sternum and upper and inferior extremities of the manubrium were moved forward to 2.39,-2.38,and 1.44mm,which did not exhibit obvious difference compared with the values taken before the operation.When two bars were used for the patients,the inferior extremity of the manubrium and each of upper,middle,and inferior extremities of the mid-sternum showed a forward displacement for 10.8,12.45,17.61,and 20.62mm,respectively.There was significant difference compared with the pre-operative values（P0.001）.The upper extremity of the manubrium exhibited forward displacement of 2.34mm,which did not exhibit any significant difference with the pre-operative values.The CT image showed the cardiac position returned to normal after operation.The thoracic appearances when two bars were used were better compared with that using one bar.Conclusions The strength of the reshaping bar is useful in thoracic bone remodeling after minimally invasive repair for PE in adult.Thoracic bone remodeling using one bar or two bars showed different change regularities and mechanisms of mechanics.