Wei Sunny, Saran Neil, Emil Sherif
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Pediatric Orthopaedics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Chest Wall Anomalies Center, Shriners Hospital for Children, Canada, Montreal, Quebec, Canada.
J Pediatr Surg. 2017 Dec;52(12):1898-1903. doi: 10.1016/j.jpedsurg.2017.08.062. Epub 2017 Sep 5.
Musculoskeletal deformities (MD), including scoliosis and chest wall anomalies, are potential long-term complications of neonatal thoracotomies.
We studied the incidence of MD in patients who underwent open repair of esophageal atresia between 1997 and 2012, had no other predisposition to MD, and subsequently received longitudinal follow-up in a multidisciplinary esophageal atresia clinic. Detailed chest wall and musculoskeletal exams were performed at each visit. Incident rate and incident rate ratios were used to determine the incidence of deformities. Logistic regression methods were used to test the effect of independent variables including sex, gestational age, muscle division, number of thoracotomies, and operative complications on the occurrence of MD.
The study cohort consisted of 52 patients followed for a median of 8 (range 1-19) years. MD developed in 13 (25%), with an incident rate of 2.92 per 100 child-years. Division of the serratus anterior was associated with a significantly higher probability of developing MD (log-rank p=.0237) and was also a strong predictor of the same [OR 8.6 (95% CI 1.8-42.1)] after adjusting for possible confounders.
Musculoskeletal deformities develop in a significant proportion of neonates following thoracotomy. A muscle-sparing technique decreases the incidence of these deformities.
Prospective Cohort Study.
II.
肌肉骨骼畸形（MD），包括脊柱侧弯和胸壁畸形，是新生儿开胸手术潜在的长期并发症。
我们研究了1997年至2012年间接受食管闭锁开放修复术、无其他MD易患因素、随后在多学科食管闭锁诊所接受纵向随访的患者中MD的发生率。每次就诊时都进行详细的胸壁和肌肉骨骼检查。发病率和发病率比用于确定畸形的发生率。采用逻辑回归方法检验包括性别、胎龄、肌肉分离、开胸次数和手术并发症等自变量对MD发生的影响。
研究队列包括52例患者，中位随访时间为8年（范围1 - 19年）。13例（25%）发生了MD，每100儿童年的发病率为2.92。前锯肌分离与发生MD的概率显著较高相关（对数秩p = 0.0237），在调整可能的混杂因素后，也是MD发生的有力预测因素[比值比8.6（95%可信区间1.8 - 42.1）]。
相当比例的新生儿开胸术后会发生肌肉骨骼畸形。保留肌肉技术可降低这些畸形的发生率。
前瞻性队列研究。
II级。
