Acastello Eduardo, Majluf Rodolfo, Garrido Patricia, Barbosa Lucrecia M, Peredo Alfredo
Department of Thoracic Surgery, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina.
J Pediatr Surg. 2003 Feb;38(2):178-83. doi: 10.1053/jpsu.2003.50038.
The aim of this study was to evaluate the results from the surgical techniques utilized to repair congenital sternal cleft.
From January, 1987 to January, 2001, 5,182 patients were seen for chest wall malformations. Eight (0.15%) had sternal cleft. The age at presentation ranged from 15 days to 5 years. Six were girls (75%). The associated malformations were congenital cardiac malformations (2 patients), maxillofacial hemangioma (1 patient). All of them underwent a surgical repair, which could be classified into 3 methods: group 1 had primary closure of the defect (3 patients); group 2 underwent partial resection of the first, second, and third costal cartilages, disruption of the sternoclavicular junction, and closure of the sternal bars with stainless steel wire (3 patients); and group 3 had mobilization and approximation of the sternocleidomastoid muscles with closure achieved with costal homograft and prosthetic mesh (2 patients). The interval for postoperative follow-up was 1 to 8 years.
Group 1 patients developed well, although 2 of them had a slight degree of pectus excavatum in the long term not requiring surgical correction. Group 2 Patients developed without problems in all cases. One of the patients from group 3 had unsatisfactory aesthetic and functional results. He underwent reoperation with the second technique, achieving an improved result.
Primary closure of the sternal cleft is the easiest technique. It should be performed in young infants. In the long term it can lead to a mild degree of pectus excavatum. The costal cartilage resection with mobilization of the clavicle achieved excellent results and allowed ready approximation of both sternal halves avoiding the use of costal grafts and prosthetic material.
本研究旨在评估用于修复先天性胸骨裂的手术技术的效果。
1987年1月至2001年1月期间，共诊治5182例胸壁畸形患者。其中8例（0.15%）患有胸骨裂。就诊时年龄为15天至5岁。6例为女孩（75%）。相关畸形包括先天性心脏畸形（2例患者）、颌面血管瘤（1例患者）。所有患者均接受了手术修复，可分为3种方法：第1组为直接缝合缺损（3例患者）；第2组进行第1、2、3肋软骨部分切除，胸锁关节离断，并用不锈钢丝缝合胸骨条（3例患者）；第3组游离并拉拢胸锁乳突肌，用肋软骨移植和人工补片缝合（2例患者）。术后随访时间为1至8年。
第1组患者恢复良好，尽管其中2例长期有轻度漏斗胸，但无需手术矫正。第2组患者均无问题。第3组中有1例患者的美观和功能效果不理想。他接受了第二种技术的再次手术，结果有所改善。
胸骨裂直接缝合是最简单的技术。应在婴儿期进行。长期来看，可能会导致轻度漏斗胸。切除肋软骨并游离锁骨的方法取得了良好效果，可使两半胸骨轻松对合，避免使用肋软骨移植和人工材料。
