Pediatric Surgical Research Institute Münster, Am Getterbach 49e, D-48163 Münster, Germany.
World J Pediatr. 2011 May;7(2):118-23. doi: 10.1007/s12519-011-0263-y. Epub 2011 May 15.
In this article we assess the significance of classifying chest-deformities based on morphological findings in type-related treatment and its results.
Recent publications on chest-deformities in children and youth were retrieved from PubMed and Medline and from our clinical and intraoperative findings.
Chest-deformities are diagnosed by thorax-measurements using a flexible meter projected on a graph-paper by MR/CT investigations and color coded videorasterstereography. In addition an ultrasound guided mediastinal analysis is performed on the heart, the great vessels and mediastinal organs. These investigations could determine meticulously the morphology of the sternum, the sterno-costal segments and the costal arch, enabling to find different chest wall deformities, i.e., 11 different types. The clinical and surgical significance of such a classification can be shown by comparing postoperative results of non-classified chest-deformities with those of classified. Preoperatively non-classified chest-deformities often have postoperative asymmetric shapes, partial local recurrences, costal arch eversions and a platythorax. Such a classification can be used to analyze and predict socalled "secondary associated alterations" of the vertebral column or mediastinal organs.
Determining the specific type of a thorax deformity could be considered a type-related physiotherapy as conservative treatment or vacuum treatment and if surgery is indicated a type-related surgical correction can be performed. A type-related and adapted surgical correction can prevent subsequent mitral valve prolapse, recurrent infections, vertebral disturbances caused by kypho-scoliosis and increasing psychological irritation. Typing chest-deformities are an additional and essential help for the surgeon to perform specific surgical procedures: detorsion of the sternum, correction of the sterno-costal region, the costal arch bow and the kind of chest wall immobilization by metal struts. It can also compare the postoperative results more accurately in similar types of chest-deformities.
本文评估了基于形态学发现对与类型相关的治疗及其结果进行分类的重要性。
从 PubMed 和 Medline 以及我们的临床和术中发现中检索了有关儿童和青少年胸廓畸形的最新出版物。
通过使用柔性米尺在 MR/CT 检查和彩色栅格体视摄影所投影的图纸上进行胸廓测量来诊断胸廓畸形。此外，还对心脏、大血管和纵隔器官进行超声引导的纵隔分析。这些检查可以细致地确定胸骨、胸骨肋部和肋弓的形态，从而发现不同的胸廓畸形，即 11 种不同类型。通过比较非分类胸廓畸形与分类胸廓畸形的术后结果，可以显示这种分类的临床和手术意义。术前未分类的胸廓畸形往往术后形状不对称、局部复发部分、肋弓外翻和扁平胸。这种分类可用于分析和预测所谓的脊柱或纵隔器官的“继发性相关改变”。
确定胸廓畸形的具体类型可以被认为是一种与类型相关的物理治疗，如保守治疗或真空治疗，如果需要手术，则可以进行与类型相关的手术矫正。与类型相关和适应的手术矫正可以预防随后的二尖瓣脱垂、反复感染、由脊柱侧凸引起的椎体紊乱以及增加的心理刺激。对胸廓畸形进行分类是外科医生进行特定手术程序的额外和重要帮助：胸骨扭转、胸骨肋区、肋弓弓和金属支架固定的胸廓的矫正。它还可以更准确地比较类似类型的胸廓畸形的术后结果。
