Serafin J, Swiatkowski J, Majkusiak R, Nowakowski P
Department of Orthopaedic of the Warsaw Medical Academy.
Acta Chir Orthop Traumatol Cech. 2003;70(4):207-13.
The aim of this study was to assess the results of surgical treatment of 58 patients with pectus excavatum and 11 with pectus carinatum and discuss the problems connected with ethiopathogenesis and operative techniques.
69 chest deformations treated between 1961-2001.
The clinical results were analyzed with 1) Kopera-Król Rtg-index, 2) Gizycka's Rtg-index of chest flattening, 3) Haller and Nakahara CT-index, 4) Heart position after operation, 5) Frequency of upper respiratory infections, 6) Appearance of postoperative scar, 7) Patient's opinion. Histopathological investigations were used to assess ethiopathogenesis of chest deformations.
90% permanent correction achieved in group of patients operated in the age from 12 to 17. Otherwise we noted between the patients who were operated in the age from 6 to 10-37% recurrence of deformity. Generally we had 70% excellent and good results. The opinion of patients (including cosmetics effects, psychical state and exercise tolerance) was much better-86.6%. Particularly correction of pectus carinatum gives good cosmetics effects as well as improvement of exercise tolerance.
Nuss modified correction employing a substernal stabilizing plate is an alternative for transsternal traction in the classical Ravitsch' procedure. Authors present advantages and disadvantages of both methods. The optimal age for surgical correction and inter and post operative procedure are discussed.
Ethipathogenesis of pectus excavatum and carinatum remains unsettled. Disturbances in endochondral ossification and growth of costal cartilage seem to be more probable cause of the deformities than diaphragm underdevelopment. Mild and severe forms of the two deformities result in circulatory-respiratory malfunctions, cosmetic defects and psychical problems. Due to possible circulatory-respiratory disorder, appropriate premedication as well as intra- and postoperative monitoring of RR, ECG, O2, CO2 are very important on the first day after the surgery. Ravistch-Garnier procedure for pectus excavatum and Chen procedure for pectus carinatum remain operations of choice. Transsternal traction can be replaced with internal stabilisation with a bar placed under the sternum what considerably reduces the time of hospitalisation but requires one more hospitalisation to remove the bar. Correction of pectus carinatum is permanent, correction of pectus excavatum turned out to be permanent in 90% cases providing that they were performed in patients aged 12-16. When patients were at the age 6-10, recurrence of the deformity occurred in 37% of cases. According to the clinical assessment, in both age groups, the proportion of very good or good scores equalled 70% and according to patient's evaluation--86.6%.
本研究旨在评估58例漏斗胸患者和11例鸡胸患者的手术治疗结果，并探讨与病因发病机制及手术技术相关的问题。
1961年至2001年间治疗的69例胸部畸形病例。
采用以下指标分析临床结果：1）科佩拉-克罗尔X线指数；2）吉齐茨卡胸部扁平X线指数；3）哈勒和中原CT指数；4）术后心脏位置；5）上呼吸道感染频率；6）术后瘢痕外观；7）患者意见。采用组织病理学研究评估胸部畸形的病因发病机制。
12至17岁接受手术的患者组实现了90%的永久矫正。否则，我们注意到6至10岁接受手术的患者中，有37%出现畸形复发。总体而言，我们取得了70%的优良结果。患者的意见（包括美容效果、心理状态和运动耐量）要好得多，为86.6%。特别是鸡胸的矫正具有良好的美容效果，并能改善运动耐量。
采用胸骨下稳定板的努斯改良矫正术是经典拉维奇手术中经胸骨牵引的替代方法。作者介绍了两种方法的优缺点。讨论了手术矫正的最佳年龄以及术中和术后程序。
漏斗胸和鸡胸的病因发病机制仍未明确。软骨内骨化和肋软骨生长紊乱似乎比膈肌发育不全更可能是畸形的原因。两种畸形的轻度和重度形式都会导致循环呼吸功能障碍、美容缺陷和心理问题。由于可能出现循环呼吸紊乱，术后第一天进行适当的术前用药以及对RR、ECG、O2、CO2进行术中和术后监测非常重要。漏斗胸的拉维奇-加尼尔手术和鸡胸的陈手术仍然是首选手术。经胸骨牵引可被胸骨下放置横杆的内固定所取代这大大缩短了住院时间，但需要再住院一次取出横杆。鸡胸的矫正效果是永久性的，漏斗胸的矫正在90%的病例中是永久性的，前提是手术在12至16岁的患者中进行。当患者年龄在6至10岁时，37%的病例出现畸形复发。根据临床评估，在两个年龄组中，非常好或好的评分比例均为70%，根据患者评估为86.6%。
