Park Chul Hwan, Kim Tae Hoon, Haam Seok Jin, Lee Sungsoo
Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Thorac Cardiovasc Surg. 2015 Aug;63(5):427-32. doi: 10.1055/s-0034-1395394. Epub 2014 Nov 11.
To evaluate whether the overgrowth of costal cartilage exists in patients with pectus excavatum, we compared the length of the costal cartilage and ribs between patients with asymmetric pectus excavatum and controls without chest wall deformity using three-dimensional computed tomography.
Nineteen adult patients with asymmetric pectus excavatum and 19 age and sex matched controls without chest wall deformity were enrolled. We measured the full lengths of the fourth to sixth ribs and costal cartilage using three-dimensional volume-rendered computed tomography images and curved multiplanar reformatting techniques. The lengths of ribs and costal cartilage, their summations, and the costal index ([length of cartilage/length of rib] × 100 [%]) were compared on the asymmetrically depressed side of patients (Group A), the opposite side of the same patients (Group B), and controls (Group C) at the fourth to sixth levels.
The lengths of the ribs of groups A and B were significantly longer (p < 0.001) than those of group C (299.4 ± 14.9 mm vs. 302.9 ± 15.3 mm vs. 288.9 ± 12.2 at the fourth level, 312.3 ± 14.1 mm vs. 318.4 ± 14.6 mm vs. 303.2 ± 12.7 mm at the fifth level, and 322.2 ± 17.2 mm vs. 325.2 ± 17.5 mm vs. 309.4 ± 12.3 mm at the sixth level). The costal cartilage lengths did not differ (p > 0.05) among the three groups (53.1 ± 7.3 mm vs. 54.6 ± 8.6 mm vs. 52.9 ± 5.2 at the fourth level, 71.9 ± 9.6 mm vs. 72.3 ± 9.9 mm vs. 69.2 ± 7.1 mm at the fifth level, and 100.1 ± 15.2 mm vs. 104.2 ± 15.8 mm vs. 99.1 ± 9.1 mm at sixth level). The summations of the rib and costal cartilage lengths were longer in groups A and B than in group C. The costal indices were not different among the three groups at the fourth, fifth, and sixth rib levels.
In patients who had asymmetric pectus excavatum with a ≥ 21-degree angle of sternal rotations, the ribs but not the costal cartilage were longer than those of controls. These findings suggest that cartilage overgrowth is not the main factor responsible for asymmetric pectus excavatum, and it could instead be related to abnormal rib growth.
为评估漏斗胸患者是否存在肋软骨过度生长，我们使用三维计算机断层扫描比较了不对称漏斗胸患者与无胸壁畸形对照者的肋软骨和肋骨长度。
纳入19例成年不对称漏斗胸患者及19例年龄和性别匹配的无胸壁畸形对照者。我们使用三维容积再现计算机断层扫描图像和曲面多平面重组技术测量第四至第六肋骨及肋软骨的全长。比较患者不对称凹陷侧（A组）、同一患者的对侧（B组）及对照者（C组）第四至第六水平肋骨和肋软骨的长度、它们的总和以及肋指数（[软骨长度/肋骨长度]×100 [%]）。
A组和B组的肋骨长度显著长于C组（第四水平：299.4±14.9mm vs. 302.9±15.3mm vs. 288.9±12.2mm；第五水平：312.3±14.1mm vs. 318.4±14.6mm vs. 303.2±12.7mm；第六水平：322.2±17.2mm vs. 325.2±17.5mm vs. 309.4±12.3mm，p<0.001）。三组间肋软骨长度无差异（p>0.05）（第四水平：53.1±7.3mm vs. 54.6±8.6mm vs. 52.9±5.2mm；第五水平：71.9±9.6mm vs. 72.3±9.9mm vs. 69.2±7.1mm；第六水平：100.1±15.2mm vs. 104.2±15.8mm vs. 99.1±9.1mm）。A组和B组肋骨与肋软骨长度总和长于C组。第四、第五和第六肋骨水平三组间肋指数无差异。
在胸骨旋转角度≥21度的不对称漏斗胸患者中，肋骨而非肋软骨比对照者长。这些发现表明软骨过度生长不是不对称漏斗胸的主要原因，相反可能与肋骨异常生长有关。
