Ohno K, Morotomi Y, Harumoto K, Ueda M, Nakahira M, Nakamura T, Azuma T, Moriuchi T, Yoshida T, Shiokawa C, Nakaoka T
Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan.
Eur J Pediatr Surg. 2006 Jun;16(3):155-9. doi: 10.1055/s-2006-924309.
Bone scintigraphy was performed to elucidate the effects of the Nuss procedure for pectus excavatum on the bony thorax.
Eight boys and 6 girls (5 - 24 years of age) underwent bone scintigraphy, using (99m)Tc-HMDP. Eleven patients were studied 5 to 21 days after the Nuss procedure; 6 were studied 20 to 24 months after the operation before bar removal. Three of 14 were studied twice after the Nuss procedure and before bar removal.
In the early postoperative phase, RI accumulation was found at the sternum and ribs in only 1 of 6 patients under 9 years of age, whereas in all 5 older patients, RI had accumulated at the sternum. Scintigrams before bar removal revealed, regardless of age, hot spots at the lateral ribs in contact with the bar and at the costochondral junctions where the bar passed through the intercostal spaces. Furthermore, chest roentgenograms showed the deformed lateral ribs in contact with the bar.
The Nuss procedure creates minute fractures at the sternum and the ribs, especially in older patients. The bar deforms the ribs and restrains the growth of the thorax. Furthermore, it constantly rubs against the ribs and can therefore cause late complications. Bone scintigraphy may determine the appropriate timing for bar removal.
进行骨闪烁显像以阐明漏斗胸Nuss手术对胸廓骨骼的影响。
8名男孩和6名女孩（5 - 24岁）接受了使用（99m）Tc - HMDP的骨闪烁显像。11例患者在Nuss手术后5至21天接受研究；6例在手术20至24个月后、取出钢板前接受研究。14例中的3例在Nuss手术后至取出钢板前接受了两次研究。
术后早期，6例9岁以下患者中仅1例在胸骨和肋骨处发现放射性核素（RI）积聚，而5例年龄较大的患者中，胸骨处均有RI积聚。取出钢板前的闪烁显像显示，无论年龄大小，与钢板接触的外侧肋骨以及钢板穿过肋间间隙的肋软骨交界处均出现热点。此外，胸部X线片显示与钢板接触的外侧肋骨变形。
Nuss手术会在胸骨和肋骨处造成微小骨折，尤其是在年龄较大的患者中。钢板会使肋骨变形并限制胸廓生长。此外，它会持续摩擦肋骨，因此可能导致晚期并发症。骨闪烁显像可确定取出钢板的合适时机。
