Emil Sherif, Sévigny Marika, Montpetit Kathleen, Baird Robert, Laberge Jean-Martin, Goyette Jade, Finlay Ian, Courchesne Guylaine
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre; Chest Wall Anomaly Center, Shriners Hospital for Children, Montreal, Canada.
J Pediatr Surg. 2017 Jan;52(1):124-129. doi: 10.1016/j.jpedsurg.2016.10.032. Epub 2016 Oct 27.
This study sought to establish factors that can prognosticate outcomes of bracing for pectus carinatum (PC).
Prospective data were collected on all patients enrolled in a dynamic bracing protocol from July 2011 to July 2015. Pressure of correction (POC) was measured at initiation of treatment, and pressure of treatment (POT) was measured pre- and post-adjustment at every follow-up visit. Univariate and Cox regression analysis tested the following possible determinants of success and bracing duration: age, sex, symmetry, POC, and POT drop during the first two follow-up visits.
Of 114 patients, 64 (56%) succeeded, 33 (29%) were still in active bracing, and 17 (15%) failed or were lost to follow-up. In successful patients, active and maintenance bracing was 5.66±3.81 and 8.80±3.94months, respectively. Asymmetry and older age were significantly associated with failure. Multivariable Cox proportional hazard analysis of time-to-maintenance showed that asymmetry (p=0.01) and smaller first drop in POT (p=0.02) were associated with longer time to reach maintenance.
Pressure of correction does not predict failure of bracing, but older age, asymmetry, and smaller first drop in pressure of treatment are associated with failure and longer bracing duration.
Prospective Study/Level of Evidence IV.
本研究旨在确定可预测鸡胸（PC）支具治疗结果的因素。
收集了2011年7月至2015年7月纳入动态支具治疗方案的所有患者的前瞻性数据。在治疗开始时测量矫正压力（POC），并在每次随访时测量调整前后的治疗压力（POT）。单因素和Cox回归分析测试了以下可能决定成功和支具治疗持续时间的因素：年龄、性别、对称性、POC以及前两次随访期间的POT下降情况。
114例患者中，64例（56%）成功，33例（29%）仍在进行积极支具治疗，17例（15%）失败或失访。成功患者的积极支具治疗和维持支具治疗时间分别为5.66±3.81个月和8.80±3.94个月。不对称和年龄较大与治疗失败显著相关。对达到维持阶段时间的多变量Cox比例风险分析表明，不对称（p = 0.01）和首次POT下降较小（p = 0.02）与达到维持阶段的时间较长有关。
矫正压力不能预测支具治疗失败，但年龄较大、不对称以及首次治疗压力下降较小与治疗失败和支具治疗持续时间较长有关。
前瞻性研究/证据水平IV。
