Nagasao Tomohisa, Miyamoto Junpei, Tamaki Tamotsu, Ichihara Kazuhiko, Jiang Hua, Taguchi Toshihiko, Yozu Ryohei, Nakajima Tatsuo
Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2007 Dec;134(6):1502-7. doi: 10.1016/j.jtcvs.2007.08.013.
In the Nuss procedure, in which the deformed thorax is forcibly corrected by insertion of correction bars, considerable stresses occur on the patient's thorax. We performed the present study to elucidate how stress patterns on the thorax after this procedure differ between child and adult patients.
Eighteen patients with pectus excavatum, constituting a child group (n = 10) and an adult group (n = 8), were included in the study. After a 3-dimensional computer-assisted design model was produced with computed tomographic data from each patient, simulation of the Nuss procedure was performed on the model. Then the stresses occurring on each thorax were calculated using the finite element method. The stresses were compared between the child and adult groups in terms of intensity on each rib and the distribution patterns over the whole thorax.
With all 12 ribs, significantly greater stress occurred in the adult group than stress in the child group. Although the stresses occurring on the thorax demonstrated concentrated patterns in the child group, widely distributed patterns were observed in the adult group.
The stresses that occur on the thorax after the Nuss procedure take different patterns between children and adults in terms of intensity and distribution. The differences should be taken into consideration in managing postoperative pain after the Nuss procedure.
在努斯手术中，通过插入矫正棒强行矫正胸廓畸形，患者胸廓会承受相当大的应力。我们开展本研究以阐明该手术后儿童和成年患者胸廓的应力模式有何不同。
本研究纳入了18例漏斗胸患者，分为儿童组（n = 10）和成年组（n = 8）。利用每位患者的计算机断层扫描数据生成三维计算机辅助设计模型后，在模型上进行努斯手术模拟。然后使用有限元方法计算每个胸廓上产生的应力。从每根肋骨上的应力强度以及整个胸廓的分布模式方面对儿童组和成年组的应力进行比较。
在所有12根肋骨上，成年组产生的应力显著大于儿童组。虽然儿童组胸廓上产生的应力呈集中模式，但成年组观察到的是广泛分布模式。
努斯手术后胸廓上产生的应力在强度和分布方面儿童与成人有所不同。在处理努斯手术后的疼痛时应考虑到这些差异。
