de Beer Sjoerd A, Gritter Martin, de Jong Justin R, van Heurn Ernst L W
Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands.
Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands.
Ann Thorac Surg. 2017 Jun;103(6):1742-1749. doi: 10.1016/j.athoracsur.2016.12.019. Epub 2017 Mar 6.
Dynamic brace compression is a novel treatment for patients with pectus carinatum. The dynamic compression system contains a device to measure the flexibility of the thoracic wall and regulate the pressure of the brace.
Patients referred to our pediatric surgical center were screened for treatment with the dynamic compression brace. Patients with a pressure of initial correction (PIC) of 10.0 pounds per square inch or less were offered treatment with the brace. Patients with a PIC above 10.0 pounds per square inch were offered surgical correction. Between March 2013 and April 2016, 286 patients were treated with the brace; 260 were male (91%) and 26 were female (9%). Their mean age was 14 years (range, 4 to 21 years).
Seventy-eight patients completed brace treatment; the mean treatment time was 14 months. Twenty-seven patients abandoned treatment because of lack of motivation, loss to follow-up, persistent protrusion of the sternal bone or flaring that required surgical correction, failure of treatment because of a bifid rib, fear of locking the brace, and delayed correction. One hundred eighty-one patients are still wearing the brace, either in the active or in the retainer phase. Patients with a high PIC also showed improvement when they were compliant. Adverse events were minor and included skin lesions (n = 4, 1%) and vasovagal reactions at the start of therapy (n = 3, 1%).
These data show that brace therapy can be considered a valuable treatment option to correct pectus carinatum in patients with a flexible thorax.
动态支具加压是鸡胸患者的一种新型治疗方法。动态加压系统包含一个用于测量胸壁柔韧性并调节支具压力的装置。
对转诊至我们儿科外科中心的患者进行动态加压支具治疗筛查。初始矫正压力（PIC）为每平方英寸10.0磅或更低的患者接受支具治疗。PIC高于每平方英寸10.0磅的患者接受手术矫正。2013年3月至2016年4月期间，286例患者接受了支具治疗；其中260例为男性（91%），26例为女性（9%）。他们的平均年龄为14岁（范围4至21岁）。
78例患者完成了支具治疗；平均治疗时间为14个月。27例患者因缺乏动力、失访、胸骨持续突出或外翻需要手术矫正、因分叉肋骨导致治疗失败、害怕支具锁定以及矫正延迟而放弃治疗。181例患者仍在佩戴支具，处于活动期或维持期。PIC高的患者在依从治疗时也有改善。不良事件轻微，包括皮肤损伤（n = 4，1%）和治疗开始时的血管迷走反应（n = 3，1%）。
这些数据表明，支具治疗可被视为矫正胸廓柔韧性好的鸡胸患者的一种有价值的治疗选择。
