Schoenmakers M A, Gulmans V A, Bax N M, Helders P J
Department of Paediatric Physiotherapy, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
J Pediatr Surg. 2000 Oct;35(10):1440-3. doi: 10.1053/jpsu.2000.16409.
The authors postulated that physiotherapy as an adjuvant to the surgical treatment of anterior chest wall deformities is only indicated if specific abnormalities can be found that could be corrected by physiotherapy. The purpose of this study is to investigate whether such abnormalities can be found and to evaluate their course during a postoperative period of 18 months.
Twenty-one patients, 16 with pectus excavatum and 5 with pectus carinatum, were evaluated 6 weeks before and 6 weeks, 6 months, and 18 months after surgical correction. Postural impairments, spinal mobility and curvature, muscle strength, and muscle length were evaluated.
Preoperatively, poor posture was seen in 10 patients, nonstructural scoliosis in 11, and abdominal muscle weakness in 4 patients. None of the patients had restriction of spinal mobility or shortened pectoral muscles. Six weeks after surgery, poor posture was seen in 9, nonstructural scoliosis in 11, and abdominal muscle weakness in 10 patients. The authors found a higher percentage of recovery for abdominal muscle weakness than for poor posture (90% versus 33%, respectively).
The authors found preoperative postural impairments in 52% of their patients, in patients with pectus carinatum as well as in patients with pectus excavatum. In patients without postural impairments, physiotherapy is not necessary, with the exception of postoperative pulmonary care.
作者推测，只有在发现可通过物理治疗纠正的特定异常情况时，物理治疗作为前胸壁畸形手术治疗的辅助手段才适用。本研究的目的是调查是否能发现此类异常情况，并评估其在术后18个月期间的变化过程。
对21例患者进行评估，其中16例漏斗胸患者和5例鸡胸患者，在手术矫正前6周以及术后6周、6个月和18个月进行评估。评估姿势障碍、脊柱活动度和曲度、肌肉力量以及肌肉长度。
术前，10例患者存在姿势不良，11例存在非结构性脊柱侧弯，4例存在腹肌无力。所有患者均无脊柱活动受限或胸肌缩短的情况。术后6周，9例患者存在姿势不良，11例存在非结构性脊柱侧弯，10例存在腹肌无力。作者发现腹肌无力的恢复百分比高于姿势不良（分别为90%和33%）。
作者发现，在漏斗胸患者和鸡胸患者中，52%的患者术前存在姿势障碍。对于无姿势障碍的患者，除术后肺部护理外，无需进行物理治疗。
