Snyder Christopher W, Farach Sandra M, Litz Cristen N, Danielson Paul D, Chandler Nicole M
Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; 6th Medical Group, MacDill Air Force Base, Tampa, Florida; Division of Acute Care Surgery, Tampa General Hospital, University of South Florida, Tampa, Florida.
Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
J Pediatr Surg. 2017 Jul;52(7):1098-1101. doi: 10.1016/j.jpedsurg.2017.01.053. Epub 2017 Jan 31.
Current approaches to quantifying the severity of pectus excavatum require internal measurements based on cross-sectional imaging. This study evaluated the modified percent depth (MPD), a novel index of severity that can be obtained with external measurements, potentially avoiding the need for cross-sectional imaging.
Patients undergoing surgical repair of pectus excavatum (pectus group), and those undergoing cross-sectional imaging for unrelated reasons (control group), between 2010 and 2016 were included. The MPD of the deformity was calculated using external (i.e. skin surface to skin surface) measurements from the radiographic images. The same external measurements were taken using chest calipers on a subset of these patients in the outpatient clinic. The optimal threshold for MPD that defined severe pectus deformity was derived from receiver-operator characteristic (ROC) analysis. Sensitivity and specificity of the MPD was compared with that of the Haller Index (HI) and Correction Index (CI).
There were 92 children (49 pectus, 43 controls) included. The median MPD was 20.2% and 4.2% for pectus and control patients, respectively (p<0.0001). An MPD cutoff of 10% optimally discriminated between severe pectus patients and controls by ROC analysis. An MPD of >10% had 98% sensitivity and 98% specificity for severe pectus deformity. Sensitivity and specificity were respectively 93% and 93% for HI >3.25, and 100% and 79% for CI >10.
An MPD >10% performs slightly better than the HI and CI in distinguishing patients with severe pectus deformities. This novel measurement approach offers distinct advantages over existing indices, in that it does not require cross-sectional imaging and can be done using chest calipers in the office setting. Further studies with larger sample size are needed to verify reproducibility of the technique.
Level II, Study of Diagnostic Test.
目前量化漏斗胸严重程度的方法需要基于横断面成像进行内部测量。本研究评估了改良深度百分比（MPD），这是一种可通过外部测量获得的新型严重程度指标，有可能避免进行横断面成像的需求。
纳入2010年至2016年间接受漏斗胸手术修复的患者（漏斗胸组）以及因无关原因接受横断面成像的患者（对照组）。使用来自X线影像的外部（即皮肤表面到皮肤表面）测量值计算畸形的MPD。在门诊对这些患者的一个亚组使用胸径测量卡尺进行相同的外部测量。通过受试者操作特征（ROC）分析得出定义严重漏斗胸畸形的MPD最佳阈值。将MPD的敏感性和特异性与哈勒指数（HI）和矫正指数（CI）的敏感性和特异性进行比较。
共纳入92名儿童（49名漏斗胸患者，43名对照）。漏斗胸患者和对照患者的MPD中位数分别为20.2%和4.2%（p<0.0001）。通过ROC分析，MPD临界值为10%时能最佳地区分严重漏斗胸患者和对照。MPD>10%对严重漏斗胸畸形的敏感性和特异性分别为98%和98%。HI>3.25时敏感性和特异性分别为93%和93%，CI>10时敏感性和特异性分别为100%和79%。
MPD>10%在区分严重漏斗胸畸形患者方面比HI和CI表现稍好。这种新型测量方法相对于现有指标具有明显优势，因为它不需要横断面成像，并且可以在门诊使用胸径测量卡尺完成。需要进行更大样本量的进一步研究以验证该技术的可重复性。
二级，诊断试验研究。
