单侧固定片附加钢丝固定改良方法在儿童Nuss手术中应用的临床研究

Clinical application of modified method of additional steel wire for fixing unilateral flap during Nuss procedure in children

目的:探讨儿童Nuss手术中使用单侧固定片附加钢丝固定改良方法的临床经验及预防钢板移位效果。方法:以昆明市儿童医院2006年10月至2018年12月930例Nuss手术患儿为研究对象进行回顾性研究,将在2006年10月至2015年12月采用单侧固定片与胸壁肌肉、筋膜包埋缝合固定方法的602例患儿(对照组)与在2016年1月至2018年12月采用单侧固定片附加钢丝固定改良方法的328例患儿(改良组)比较,从Haller指数、凹陷胸壁被矫治的外观效果、患儿及其家长对手术效果的满意程度及胸廓的饱满程度、伸展性和弹性等方面评价其手术效果。结果:930例患儿均顺利实施Nuss手术,术后1周手术疗效评估满意。两组患儿在术前体重、年龄、营养、影像学检查等方面比较P>0.05,差异无统计学意义。对照组和改良组患儿在手术时间、出血量、术后住院时间、术后影像学检查、术后钢板取出时间及住院费用等方面比较P>0.05,差异无统计学意义。4.3%(26/602)的对照组患儿术后发生钢板移位。改良组患儿术后无钢板移位发生,两组比较P<0.01,差异有明显统计学意义。结论:附加钢丝固定单侧固定片改良方法在儿童Nuss手术中操作安全、易行,没有额外增加手术时间、出血量及手术难度,预防钢板移位效果明确,我院现已将此改良方法常规用于儿童Nuss手术中。

Objective To explore the clinical experience of modified method of additional unilateral wire fixation during pediatric Nuss procedures and the effect of preventing plate displacement.Methods A retrospective study was conducted for 930 children undergoing Nuss procedures from October 2006 to December 2018.Control group was composed of 602 cases of unilateral fixed flap for embedding suturing thoracic wall muscle and fascia while modified group included 328 cases undergoing modified method of additional steel wire for fixing unilateral flap.Surgical outcomes were evaluated by Haller's index,appearance effect of correcting chest wall,patient/parental satisfactory degree of surgical efficacy and thoracic fullness/stretch/elasticity.Results All Nuss procedures were performed successfully and surgical efficacy was satisfactory at Week 1 postoperatively.Preoperative weight,age,nutrition and imaging examinations showed no statistically significant inter-group difference(P>0.05).No statistically significant difference existed in operative duration,amount of bleeding,duration of postoperative hospitalization,postoperative imaging examinations,postoperative plate removal time or hospitalization expenses(P>0.05).Postoperative plate displacement occurred with an incidence of 4.3%(26/602)in control group while modified group had none.There were significant inter-group statistical differences(P<0.01).Conclusions The modified method of additional steel wire for fixing unilateral flap is both safe and effective during Nuss procedures.It brings no addition of operative duration,blood loss or operative difficulty.The efficacy of preventing plate displacement is definite.Our hospital now has applied this method routinely during pediatric Nuss procedures.