Regional Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
Br J Surg. 2011 Nov;98(11):1660-5. doi: 10.1002/bjs.7596. Epub 2011 Jul 12.
Modified Ravitch and Nuss procedures use a metal bar to repair pectus chest deformity; an additional procedure is required to remove the bar. The aim of this study was to examine mid-term results of a novel technique that uses the patient's own chest wall muscles to stabilize the pectus repair aided by a posture-maintaining exercise regimen.
Thirty-two consecutive patients with pectus deformity underwent pectus repair without prosthesis between 1999 and 2008. The median age of the group was 18 (95 per cent confidence interval (c.i.) 14 to 34) years. Median follow-up was 44 (7 to 108) months. Twenty patients had an excavatum and 12 a carinatum defect. Surgery was performed through a transverse incision raising pectoralis and rectus muscle flaps. The sternum was released to a neutral position and stabilized to the overlying muscle raphe closure. Patient satisfaction was assessed with a single-step questionnaire.
Median length of stay was 6 (95 per cent c.i. 4 to 7) days. Two patients returned to theatre for bleeding, two had a superficial wound infection and four developed a seroma. No patient had recurrence. There was a significant improvement in self-esteem (P < 0·001) and a high level of overall satisfaction (median score 72, 95 per cent c.i. 56 to 80).
This non-prosthetic pectus deformity repair was effective with low serious morbidity and high patient satisfaction without the inherent disadvantages of using a metal bar.
改良 Ravitch 和 Nuss 手术采用金属棒修复鸡胸畸形；需要额外的手术来移除棒。本研究旨在检查一种新的技术的中期结果，该技术使用患者自身的胸壁肌肉来稳定由保持姿势的运动方案辅助的鸡胸修复。
1999 年至 2008 年间，32 例连续的鸡胸畸形患者接受了无假体的鸡胸修复手术。该组的平均年龄为 18 岁（95%置信区间（c.i.）为 14 至 34 岁）。中位数随访时间为 44 个月（7 至 108 个月）。20 例患者存在凹陷畸形，12 例患者存在隆凸畸形。手术通过横切口提起胸大肌和腹直肌皮瓣进行。胸骨被释放到中立位置，并固定在上方的肌肉缝线上。采用一步法问卷调查评估患者的满意度。
平均住院时间为 6 天（95%置信区间（c.i.）为 4 至 7 天）。有 2 例患者因出血返回手术室，2 例患者有浅表伤口感染，4 例患者发生血清肿。无患者出现复发。患者的自尊心有显著改善（P < 0.001），总体满意度高（中位数评分为 72，95%置信区间（c.i.）为 56 至 80）。
这种非假体鸡胸畸形修复效果好，严重发病率低，患者满意度高，没有使用金属棒的固有缺点。
