三维计算机断层扫描在儿童复杂胸廓畸形的评估和管理中的应用：有用的信息还是只是漂亮的图片？
Three-dimensional computed tomography for evaluation and management of children with complex chest wall anomalies: useful information or just pretty pictures?
机构信息
Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
出版信息
J Pediatr Surg. 2011 Apr;46(4):640-647. doi: 10.1016/j.jpedsurg.2010.10.013.
PURPOSE
Shaded surface display (SSD) technology, with 3-dimensional computed tomography reconstruction, has been reported in a few small series of patients with congenital or acquired chest wall deformities. Shaded surface display images are visually attractive and educational, but many institutions are hesitant to use these secondary to cost and image data storage concerns. This study was designed to assess the true value of SSD to the patient, family, and operating surgeon, in the evaluation and management of these children.
METHODS
After institutional review board approval, we performed a retrospective review of records of 82 patients with chest wall deformities, evaluated with SSD, from 2002 to 2009. Shaded surface display usefulness, when compared to routine 2-dimensional computed tomography, was graded on a strict numerical scale from 0 (added no value besides education for the patient/family) to 3 (critical for surgical planning and patient management).
RESULTS
There were 56 males and 26 females. Median age was 15.3 years (range, 0.6-41.1 years). Deformities included 56 pectus excavatum, 19 pectus carinatum, and 8 other/mixed deformities. Six patients also had acquired asphyxiating thoracic dystrophy (AATD). Eleven (13%) had previous chest wall reconstructive surgery. In 25 (30%) patients, SSD was useful or critical. Findings underappreciated on 2-dimensional images included sternal abnormalities (29), rib abnormalities (28), and heterotopic calcifications (7). Shaded surface display changed or influenced operation choice (4), clarified bone vs soft tissue (3), helped clarify AATD (3), and aided in rib graft evaluation (2). Point biserial correlation coefficient analysis (R(pb)) displayed significance for SSD usefulness in patients with previous chest repair surgery (R(pb) = 0.48, P ≤ .001), AATD (R(pb) = 0.34, P = .001), pectus carinatum (R(pb) = 0.27, P = .008), and females (R(pb) = 0.19, P = .044).
CONCLUSIONS
Shaded surface display, when used to evaluate children and young adults with congenital or acquired chest wall deformities, provides useful or critical information for surgical planning and patient management in almost one third of patients, especially in those requiring a second operation, with acquired asphyxiating thoracic dystrophy, pectus carinatum, and females.
目的
三维计算机断层扫描重建的阴影表面显示（SSD）技术已在少数先天性或后天性胸壁畸形患者的小系列中报道。阴影表面显示图像具有视觉吸引力和教育意义，但由于成本和图像数据存储问题，许多机构都不愿意使用这些技术。本研究旨在评估 SSD 在评估和管理这些儿童患者、家属和手术医生方面的真正价值。
方法
经机构审查委员会批准，我们对 2002 年至 2009 年间接受 SSD 评估的 82 例胸壁畸形患者的记录进行了回顾性分析。根据严格的数值评分，将 SSD 的有用性与常规二维计算机断层扫描进行比较，评分为 0（除了为患者/家属提供教育外，没有增加任何价值）至 3（对手术计划和患者管理至关重要）。
结果
男性 56 例，女性 26 例。中位年龄为 15.3 岁（范围：0.6-41.1 岁）。畸形包括 56 例漏斗胸、19 例鸡胸和 8 例其他/混合畸形。6 例患者还患有获得性窒息性胸壁发育不良（AATD）。11 例（13%）患者有过胸壁重建手术史。在 25 例（30%）患者中，SSD 是有用的或关键的。二维图像上低估的发现包括胸骨异常（29 例）、肋骨异常（28 例）和异位钙化（7 例）。SSD 改变或影响手术选择（4 例）、澄清骨与软组织（3 例）、有助于澄清 AATD（3 例）和辅助肋骨移植物评估（2 例）。点二列相关系数分析（R(pb)）显示 SSD 在有既往胸部修复手术史（R(pb)=0.48，P≤.001）、AATD（R(pb)=0.34，P=.001）、鸡胸（R(pb)=0.27，P=.008）和女性（R(pb)=0.19，P=.044）患者中的有用性具有显著意义。
结论
在评估先天性或后天性胸壁畸形的儿童和青少年时，阴影表面显示技术提供了有用或关键的手术计划和患者管理信息，在近三分之一的患者中，尤其是在需要再次手术、患有获得性窒息性胸壁发育不良、鸡胸和女性的患者中，这一信息具有重要意义。
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