Nagasao Tomohisa, Hamamoto Yusuke, Tamai Motoki, Kogure Tetsukuni, Jiang Hua, Takano Naoki, Tanaka Yoshio
Department of Plastic Surgery, Kagawa University, Takamastu, Kagawa, Japan.
Department of Plastic Surgery, Shanghai Second Military Medical College, Changzheng Hospital, Shanghai, China.
Thorac Cardiovasc Surg. 2016 Jan;64(1):62-9. doi: 10.1055/s-0035-1552924. Epub 2015 Jul 10.
The present study aims to elucidate whether or not scoring deformed cartilages reduces postoperative pain after the Nuss procedure for pectus excavatum patients.
A total of 46 pectus excavatum patients for whom the Nuss procedure was conducted were included in the study. The patients were categorized into two groups, depending on whether or not the supplementary maneuver of scoring deformed cartilages was performed in addition to the Nuss procedure. Patients for whom deformed costal cartilages were scored were categorized as the Scoring Group (n = 24); those who received no such scoring were categorized as the Non-Scoring Group (n = 22). After evaluating the maximum stresses occurring on the thoraces by means of dynamic simulation using finite element analyses, intergroup comparison of the maximum von-Mises stress values was performed. Furthermore, after quantifying postoperative pain as the frequency with which patients injected anesthetics through an epidural pain-control system within 2 postoperative days, the degree of pain was compared between the two groups.
The maximum stresses occurring on the thorax were significantly greater for the Non-Scoring Group than for the Scoring Group; injection frequency was also greater for the Non-Scoring Group (average 4.9 times for 2 days) than for the Scoring Group (average 2.5 times for 2 days).
High stresses occur due to the performance of the Nuss procedure, causing postoperative pain. The stresses can be reduced by performing supplementary scoring on deformed cartilages. Accordingly, postoperative pain is reduced.
本研究旨在阐明对漏斗胸患者行努氏手术时，对变形软骨进行划痕评分是否能减轻术后疼痛。
本研究纳入了46例行努氏手术的漏斗胸患者。根据在努氏手术之外是否进行了对变形软骨的辅助划痕操作，将患者分为两组。对变形肋软骨进行划痕的患者归为划痕组（n = 24）；未进行此类划痕的患者归为非划痕组（n = 22）。通过有限元分析进行动态模拟评估胸部出现的最大应力后，对两组的最大冯·米塞斯应力值进行组间比较。此外，将术后2天内患者通过硬膜外疼痛控制系统注射麻醉剂的频率作为术后疼痛的量化指标，比较两组的疼痛程度。
非划痕组胸部出现的最大应力显著高于划痕组；非划痕组的注射频率（2天平均4.9次）也高于划痕组（2天平均2.5次）。
努氏手术操作会产生高应力，导致术后疼痛。对变形软骨进行辅助划痕可降低应力。因此，术后疼痛得以减轻。
