Fokin A A, Robicsek F
The Department of Thoracic and Cardiovascular Surgery, Heineman Medical Research Laboratories, Carolinas Medical Center, Charlotte, NC 28203, USA.
Thorac Cardiovasc Surg. 2006 Feb;54(1):57-61. doi: 10.1055/s-2005-865840.
Acquired chest wall deformities are difficult to describe and to classify. We propose the following classification and treatment options.
We observed 11 patients with acquired deformities (AD) that required surgical correction.
AD of the chest can be classified into 4 groups: (1) AD resulting from a pathological process within the thorax (heart enlargement, mediastinal tumors), (2) AD resulting from chest wall disease (rib osteomyelitis or tumors), (3) iatrogenic deformities (following rib graft harvesting, acquired Jeune's syndrome), and (4) post-traumatic deformities. Group 1 requires treatment of the pathological process. Group 2 is guided by oncological or infectious disease principles. Groups 3 and 4 require chest wall reconstruction. Iatrogenic AD usually occur after pectus excavatum repair with rib cartilage extirpation in young patients, which results in a reduced, restricted thorax. Post-traumatic AD often have pathological chest wall mobility owing to pseudo-articulation of injured ribs.
To prevent AD formation and to protect thoracic growth and mobility, costosternal and costochondral junctions should be preserved during cartilage resection. Substernal suturing of the perichondrium should be avoided.
后天性胸壁畸形难以描述和分类。我们提出以下分类和治疗方案。
我们观察了11例需要手术矫正的后天性畸形（AD）患者。
胸壁AD可分为4组：（1）由胸腔内病理过程导致的AD（心脏扩大、纵隔肿瘤），（2）由胸壁疾病导致的AD（肋骨骨髓炎或肿瘤），（3）医源性畸形（取肋骨移植后、获得性儒内综合征），以及（4）创伤后畸形。第1组需要治疗病理过程。第2组遵循肿瘤学或传染病学原则。第3组和第4组需要胸壁重建。医源性AD通常发生在年轻患者行漏斗胸修复并切除肋软骨后，导致胸廓缩小、受限。创伤后AD由于受伤肋骨假关节形成，常伴有胸壁病理性活动。
为防止AD形成并保护胸廓生长和活动度，软骨切除时应保留肋胸骨和肋软骨关节。应避免胸骨下软骨膜缝合。
