漏斗胸微创矫形手术的生物力学研究进展

Biomechanical research progress on minimally invasive surgical repair of pectus excavatum

开展漏斗胸微创矫形手术的生物力学研究以及阐述矫形机制对于提高矫形手术水平、开展个性化手术治疗、发展新的矫形手术方法和扩展微创矫形手术的应用范围具有重要意义。漏斗胸微创矫形手术已经成功用于儿童的漏斗胸矫形,但是成人漏斗胸矫形手术的应用还未普及。面对漏斗胸矫形可能会加重脊柱侧弯的风险,医生被迫放弃手术,致使部分漏斗胸合并脊柱侧弯的患者终生不能得到治疗。总结漏斗胸微创矫形手术的生物力学研究进展,包括胸廓模型的三维重建、矫形模型的应用、矫形过程的数值模拟以及数值模拟结果在临床的应用。结合成人漏斗胸矫形数值模拟的特点提出解决方法,并针对漏斗胸的生物力学研究现状提出需要解决的问题,如计算模型需要考虑主要肌肉、椎间盘、前后纵韧带、椎体横凸棘间韧带和棘上韧带,验证数值计算结果的实验研究方法等。

Biomechanical research on minimally invasive surgical repair of pectus excavatum （PE） and expoun- ding its correctional mechanism are of great significance for improving the level of surgical repair, developing indi- vidualized surgical treatment, proposing new method of surgical repair and extending the application scope of minimally invasive surgical repair of PE. Minimally invasive surgical repair of PE has successfully been adopted in child PE correction, but its application in adult PE surgical repair has not been popularized. Faced with the risk of scoliosis aggravation by PE correction, doctors may have to give up the operation, thus some PE patients with scoliosis are inhibited from getting treatment in their whole lives. In this review, the biomechanical researches on minimally invasive surgical repair of PE were summarized, including the 3D reconstruction of thoracic model, the application of correctional model, the numerical simulation on correctional process and the clinical application of such numerical simulation results. The solutions for numerical simulation on adult PE correction were proposed, and the currently unresolved issues such as the inclusion of main muscles, intervertebral disks, anterior and posterior longitudinal ligaments, interspinous ligaments, supraspinous ligaments in the simulation model, as well as experimental methods for validating numerical simulation results were also proposed according to the present status of biomechanical researches on PE.