Chang Pei-Yeh, Zeng Qi, Wong Kin-Sun, Wang Chao-Jan, Chang Chee-Jen
Department of Pediatric Surgery, Chang-Gung University, Taoyuan, Taiwan.
Department of Pediatric Surgery, Capital Medical University, Beijing, China.
Thorac Cardiovasc Surg. 2016 Jan;64(1):70-7. doi: 10.1055/s-0035-1555135. Epub 2015 Jul 10.
This study radiographically examined the changes in the chest walls of patients with pectus excavatum (PE) after Nuss bar removal, to define the deformation caused by the bar and stabilizer. In the first part of the study, we compared the changes in chest radiographs of patients with PE to a preoperation PE control group. In the second part, we used multislice computed tomography (CT) scans to provide three-dimensional reconstructions with which to evaluate the changes to the thoracic wall.
Part 1 From June 2006 to August 2011, 1,125 patients with PE who had posteroanterior chest radiographs taken before undergoing the Nuss procedure at four hospitals were enrolled as a preoperative control group. At the same time, 203 patients who had the bar removed were enrolled as the study group. The maximum dimensions of the outer boundary of the first to ninth rib pairs (R1-R9, rib pair width), chest height, and chest width were measured. Part 2 Thirty-one consecutive patients with PE (20 males and 11 females) who underwent Nuss bar removal were evaluated 7 to 30 days after operation. During this period, a further 34 patients with PE who had undergone CT imaging before bar insertion were evaluated and compared with the postoperative group.
Part 1 The width of the lower ribs (R4-R9) after bar removal was significantly less than in the age-matched controls. The ribs adjacent to the bar (R5-R7) showed the greatest restriction. The width of the upper ribs (R1-R3) 2 to 3 years after bar placement did not differ significantly from the controls. Patients who were operated on after 10 years of age had less of a restrictive effect. Three years of bar placement resulted in more restriction than a 2-year period, particularly in patients younger than 10 years old. Part 2: A significant constriction of the chest wall was observed in 13 patients after removal of the Nuss bar. Constriction at ribs 5 to 8 was found to be present adjacent to the site of bar insertion. However, constriction of the chest wall was found in only 3 of the 34 patients in the preoperative group. The severity of constriction (as graded by the spline model) also increased in the postoperative group.
The growth of the chest wall was restricted after placement of the Nuss bar for PE correction. Long-term follow-up of chest wall growth is needed to clarify whether such constriction resolves with time.
本研究通过影像学检查漏斗胸（PE）患者在取出Nuss钢板后的胸壁变化，以明确钢板和固定器所导致的胸廓变形。在研究的第一部分，我们将PE患者的胸部X光片变化与术前PE对照组进行了比较。在第二部分中，我们使用多层计算机断层扫描（CT）来提供三维重建图像，以评估胸壁的变化。
第一部分：2006年6月至2011年8月，四家医院1125例在接受Nuss手术前拍摄了正位胸片的PE患者被纳入术前对照组。同时，203例已取出钢板的患者被纳入研究组。测量第一至第九肋对（R1-R9，肋对宽度）的外侧边界最大尺寸、胸廓高度和胸廓宽度。第二部分：对31例连续接受Nuss钢板取出术的PE患者（20例男性和11例女性）在术后7至30天进行评估。在此期间，对另外34例在插入钢板前已接受CT成像的PE患者进行评估，并与术后组进行比较。
第一部分：取出钢板后下肋骨（R4-R9）的宽度明显小于年龄匹配的对照组。与钢板相邻的肋骨（R5-R7）受限最为明显。放置钢板2至3年后上肋骨（R1-R3）的宽度与对照组无显著差异。10岁以后接受手术的患者受限影响较小。放置钢板3年比2年导致的受限更明显，尤其是10岁以下的患者。第二部分：13例患者在取出Nuss钢板后观察到胸壁明显收缩。发现第5至8肋在钢板插入部位附近出现收缩。然而，术前组34例患者中只有3例发现胸壁收缩。术后组收缩的严重程度（根据样条模型分级）也有所增加。
放置Nuss钢板矫正PE后胸壁生长受限。需要对胸壁生长进行长期随访，以明确这种收缩是否会随时间而缓解。
