X线胸片量化评价法评估Nuss手术对胸廓的影响

Chest X-ray film evaluate the impact of Nuss procedure on chest wall

目的应用X线胸片量化评价法评估漏斗胸患者的胸廓情况,探讨Nuss手术的效果及其对胸廓的影响。方法对北京儿童医院2006年10月至2011年2月行漏斗胸Nuss手术的患儿进行回顾性分析。根据标准选取47例患儿,测量Nuss手术前、取支架术后1周内、取支架术后6个月以上胸部X线胸片胸廓径线,3组数据与正常同龄儿童的数据进行两两比较。结果47例患儿均顺利完成Nuss手术及取支架手术,随访30~36个月,术后矫形效果优良率为100%,无复发及远期并发症。3组数据的胸廓径线呈现逐渐增长趋势,但取支架术后近期、远期与各自相对应的正常同龄儿童胸廓径线相比,Nuss支架固定位置的胸廓径线短缩,但随着Nuss支架取出后时间的推移,短缩的各胸廓径线有逐渐接近正常值的趋势。结论X线胸片量化评价法可以评估漏斗胸胸廓畸形情况和Nuss手术的矫正效果,Nuss手术矫正漏斗胸效果良好,但对胸廓生长发育存在一定的限制作用,支架取出术后远期,对胸廓生长发育的限制得到改善。

Objective To evaluate the thoracic status of patients with funnel chest by quantitative evaluation of chest X-ray, and to explore the effect of Nuss surgery. Methods From October 2006 to February 2011, according to the inclusion criteria, there were 47 cases enrolled our group at last, then divided the cases into 3 groups, including pre-operative of Nuss procedure, recent post-bar removal and further post-bar removal. We measured data on chest radiography and statistical analysis, including the maximal distance of the outer boundary of each rib pairs(C, from the 1st pair to the 9th), the distance between lung apex to the costophrenic angle(H) and the distance between the two costophrenic angles(W). Results All the 47 cases completed the Nuss procedure and Nuss bar removal safely and effectively. All the patients were followed up from 30 to 36 months, without recurrence or long-term complications. Three groups of thoracic data showed an increasing trend, recent post-bar removal and further post-bar removal compared with the same age normal children, the thoracic data of the Nuss bar position were shortened. With the prolongation of time after Nuss bar removal, thoracic data gradually approaching normal. Conclusion We can evaluate the level of pectus excavatum and effect of Nuss procedure through measuring the chest wall data. The chest wall of post-bar removal was significantly improvement compared to the cases of pre-Nuss procedure. There is some restrictions on the thoracic by the Nuss bar. we learn that the limitation of thoracic can be improve after some time.