Objective: To determine the magnitude of the effects of pectus excavatum deformity on endurance fitness and cardiorespiratory functional reserve in adolescent boys. Design: Cross-sectional comparison of cardiac and ve...Objective: To determine the magnitude of the effects of pectus excavatum deformity on endurance fitness and cardiorespiratory functional reserve in adolescent boys. Design: Cross-sectional comparison of cardiac and ventilatory variables at rest and during a maximal cycle exercise test. Setting: Pediatric exercise-testing laboratory. Participants: Twelve boys (mean ± SD age, 14.1 ± 1.8 years; age range, 11.8- 18.0 years)- with moderate-to-severe pectus excavatum deformity (mean ± SD Haller index, 3.95 ± 0.88) and 20 control boys (mean ± SD age, 12.5 ± 0.4 years; age range, 12.1- 13.5 years) without musculoskeletal deformity. Main Outcome Measures: Endurance fitness (physical work capacity); respiratory rate, tidal volume, and minute ventilation; and cardiac output and stroke volume by Doppler echocardiography. Results: Patients with pectus deformity had significantly lower endurance fitness than controls (mean± SD physicalwork capacity, 2.60± 0.28W · kg- 1 vs 3.11 ± 0.45 W · kg- 1) and reduced mean ± SD values for maximal cardiac index (10.6 ± 1.6 L· min- 1 vs 12.0 ± 2.2 L· min- 1) and peak tidal volume (3.02 ± 0.27 mL· kg- 1· 10- 2 vs 3.46 ± 0.30 mL· kg- 1· 10- 2). However, considerable overlap was observed in these values between the 2 groups. Conclusions: As a group, boys with pectus excavatum deformity have lower endurance fitness than controls, and this is associated with reduced cardiac output and tidal volume responses to exercise. However, the wide variability of these measures makes it difficult to assign pectus deformity as a cause of exercise intolerance in individual patients.展开更多
骨纤维发育不良(fibrous dysplasia of bone,FD)是一种以髓内纤维性病变为特征的类肿瘤样疾病,病变区域骨的发育停滞在未成熟的编织骨阶段,无法形成正常的骨小梁,导致骨的结构改变和力学强度降低;在负重时常出现反复的病理性骨折,进而...骨纤维发育不良(fibrous dysplasia of bone,FD)是一种以髓内纤维性病变为特征的类肿瘤样疾病,病变区域骨的发育停滞在未成熟的编织骨阶段,无法形成正常的骨小梁,导致骨的结构改变和力学强度降低;在负重时常出现反复的病理性骨折,进而继发受累骨的弯曲畸形、肢体短缩及步态异常。股骨近端是FD肢体畸形常累及的部位,畸形类型和程度复杂多样,多表现为逐渐加重的髋关节内翻及骨干弯曲。矫正畸形的目的是恢复股骨正常的机械轴线和长度,从而恢复肢体的功能,避免畸形进展以及缓解因反复的病理性微骨折而导致的疼痛症状,这较病灶本身的治疗更加重要。术前应根据病变的位置、范围以及病变类型个体化制定每一例患者的治疗方案,术后需对患者长期随访,进行矫形方案的调整。是否应进行病灶刮除植骨以及使用植骨材料的种类仍存在争议,应基于矫形原则对FD股骨进行畸形分析,确定畸形类型及畸形顶点位置,设计截骨方案,并进行术前模拟。虽然截骨后髓内或髓外固定方式均可提供足够的生物学稳定,但应根据术中具体情况决定使用何种固定装置。FD患者骨的愈合以及再生均无明显异常,但是生成的骨痂中包括发育不良的骨组织。FD患者在肢体畸形治疗后容易出现畸形复发,需长期密切随访以便进行矫形方案的调整。展开更多
文摘Objective: To determine the magnitude of the effects of pectus excavatum deformity on endurance fitness and cardiorespiratory functional reserve in adolescent boys. Design: Cross-sectional comparison of cardiac and ventilatory variables at rest and during a maximal cycle exercise test. Setting: Pediatric exercise-testing laboratory. Participants: Twelve boys (mean ± SD age, 14.1 ± 1.8 years; age range, 11.8- 18.0 years)- with moderate-to-severe pectus excavatum deformity (mean ± SD Haller index, 3.95 ± 0.88) and 20 control boys (mean ± SD age, 12.5 ± 0.4 years; age range, 12.1- 13.5 years) without musculoskeletal deformity. Main Outcome Measures: Endurance fitness (physical work capacity); respiratory rate, tidal volume, and minute ventilation; and cardiac output and stroke volume by Doppler echocardiography. Results: Patients with pectus deformity had significantly lower endurance fitness than controls (mean± SD physicalwork capacity, 2.60± 0.28W · kg- 1 vs 3.11 ± 0.45 W · kg- 1) and reduced mean ± SD values for maximal cardiac index (10.6 ± 1.6 L· min- 1 vs 12.0 ± 2.2 L· min- 1) and peak tidal volume (3.02 ± 0.27 mL· kg- 1· 10- 2 vs 3.46 ± 0.30 mL· kg- 1· 10- 2). However, considerable overlap was observed in these values between the 2 groups. Conclusions: As a group, boys with pectus excavatum deformity have lower endurance fitness than controls, and this is associated with reduced cardiac output and tidal volume responses to exercise. However, the wide variability of these measures makes it difficult to assign pectus deformity as a cause of exercise intolerance in individual patients.
文摘骨纤维发育不良(fibrous dysplasia of bone,FD)是一种以髓内纤维性病变为特征的类肿瘤样疾病,病变区域骨的发育停滞在未成熟的编织骨阶段,无法形成正常的骨小梁,导致骨的结构改变和力学强度降低;在负重时常出现反复的病理性骨折,进而继发受累骨的弯曲畸形、肢体短缩及步态异常。股骨近端是FD肢体畸形常累及的部位,畸形类型和程度复杂多样,多表现为逐渐加重的髋关节内翻及骨干弯曲。矫正畸形的目的是恢复股骨正常的机械轴线和长度,从而恢复肢体的功能,避免畸形进展以及缓解因反复的病理性微骨折而导致的疼痛症状,这较病灶本身的治疗更加重要。术前应根据病变的位置、范围以及病变类型个体化制定每一例患者的治疗方案,术后需对患者长期随访,进行矫形方案的调整。是否应进行病灶刮除植骨以及使用植骨材料的种类仍存在争议,应基于矫形原则对FD股骨进行畸形分析,确定畸形类型及畸形顶点位置,设计截骨方案,并进行术前模拟。虽然截骨后髓内或髓外固定方式均可提供足够的生物学稳定,但应根据术中具体情况决定使用何种固定装置。FD患者骨的愈合以及再生均无明显异常,但是生成的骨痂中包括发育不良的骨组织。FD患者在肢体畸形治疗后容易出现畸形复发,需长期密切随访以便进行矫形方案的调整。
