Faglin P, Nectoux É, Belkhou A, Guerreschi P, Duquennoy-Martinot V
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Salengro, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
Departement de chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, centre hospitalier régional et universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
Ann Chir Plast Esthet. 2016 Oct;61(5):680-693. doi: 10.1016/j.anplas.2016.06.010. Epub 2016 Aug 8.
Anterior chest wall deformity are mostly represented by pectus excavatum, which is a depression of the chondrosternal plastron from the 3rd to the 7th pairs of the costal cartilages, then by pectus carinatum which conversely represents a protrusion of this plastron. The major esthetic and psychosocial impact is not to be demonstrated anymore whereas the cardiopulmonary functional impact remains still highly debated. Regarding the management, curative surgical techniques such as Wurtz's sub-perichondrial simplified sternochondroplasty or Nuss' minimaly invasive technique are opposed to palliative filling technique such as customized silicone implant, lipostructure and flaps. In addition to these there are non-surgical techniques like suction bells (Vacuum Bell) for pectus excavatum or compressive orthotic bracing for pectus carinatum. The morbidity and the mortality related to some of the heavy surgeries must be weighed up with esthetic, functional or both surgical indications in order to choose the proper management. The other known deformities are much rarer. Pectus arcuatum is a combined type requiring the same management principles. Sternal cleft is caused by a fusion defect of the sternal bars, which must be treated mainly by neonatal surgery. Acquired restrictive thoracic dystrophy is a consequence of early curative surgery.
前胸壁畸形大多表现为漏斗胸，即胸骨体从第3对至第7对肋软骨处凹陷，其次为鸡胸，即胸骨体相反地向外突出。主要的美学和心理社会影响已不再有争议，而心肺功能影响仍备受争议。关于治疗方法，诸如武尔茨（Wurtz）的软骨膜下简化胸骨成形术或努斯（Nuss）的微创技术等根治性手术技术，与诸如定制硅胶植入物、脂肪结构和皮瓣等姑息性填充技术相对。除此之外，还有非手术技术，如用于漏斗胸的吸引罩（真空罩）或用于鸡胸的压迫性矫形支具。必须权衡一些大型手术相关的发病率和死亡率与美学、功能或两者的手术指征，以便选择合适的治疗方法。其他已知的畸形则更为罕见。弓形胸是一种复合型畸形，需要相同的治疗原则。胸骨裂是由胸骨条融合缺陷引起的，主要必须通过新生儿手术治疗。获得性限制性胸廓发育不良是早期根治性手术的后果。
