漏斗胸矫治矫形板取出后胸廓重塑的早期结果

Early results of thoracic remodeling for patients with bar removal after pectus excavatum correction in minimal-procedure

目的探讨漏斗胸微创矫治矫形板取出后,胸廓形状的再次重塑及疗效。方法矫治患者145例,男115例,女30例;成人59例,儿童86例。采用改进微创技术,由同一手术组完成;术后12-82个月取出矫形板。评价取出矫形板前和后1、12个月疗效,评价指标为胸廓外观、胸廓指数、胸部CT影像和CT矢状位测量胸骨后至脊柱前缘间的距离。结果胸廓形状良好。胸廓指数:取矫形板前.儿童2.36±0.32,成人2.60±0.45;取矫形板后,儿童2.77±0.44,成人3.04±0.56.取出矫形板前后比较,胸骨均有所下沉,以胸骨体下端下降最多,儿童(15.18±7.95)mm,成人(14.93士8.81)mm,取板前、后差异有统计学意义。心脏均无受压征象。在不影响胸廓发育的前提下,矫形板取出时间以儿童3年、成人5年为宜。结论漏斗胸矫治后经过一定间期再取出矫形板,胸骨有所下沉;但胸廓重塑后,胸廓形状饱满,未再发生心肺受压表现。

Objective To study thoracic re-remodeling and therapeutic effect after the bar removal for pectus excavatum corrected by minimal-invasive technique. Methods 145 cases with pectus excavatum, male 115 , femal 30;adults in 59, children 86;corrected by minimal -invasive technique improved and perfonned by the same group surgeon. Bar removed 12 - 82 months after the procedure, appraising index of curative effects include in chest appearance, thoracic index, thoracic computer tomography ( CT) and the distance between the behind of sternum to lhe anterior border of thoracic spine in the sagittal view. Results The chest shape was good. Thoracic index: before bar removal 2. 36 ± 0. 32 in children, 2. 60 ± 0. 45 in adults;after that, 2. 77 ±0. 44 in children, 3.04 ±0. 56 in adults. There was all subsidence on the each point of the sternum, descent lhe maximum at the inferior end of the midstemuni,( 15. 18 土7. 95 ) mm in children,( 14. 93 ±8.81) mm in adults, comparing with bar removal before and after. There was statistical significance. Not the signs of compressing the heart on the CT view. The time interval of the bar removed 3-year in children, 5-year in adults without affecting the development of the patients* thorax. Conclusion The sternum descended slightly after bar removal when pectus excavatum corrected to expecting effects. After that, thoracic remodeling again, the chest shape well.