Bond Sheldon J, Rapstine Emily, Bond Jordan M
Department of Surgery, Division of Pediatric Surgery, University of Louisville, 315 E. Broadway, Ste 565, Louisville, KY, 40202, USA.
Department of Surgery, University of Louisville, Louisville, KY, USA.
Pediatr Surg Int. 2018 Jan;34(1):75-78. doi: 10.1007/s00383-017-4195-z. Epub 2017 Oct 19.
This study reviews the results of our previously described modification of the minimally invasive (Nuss) procedure for correction of pectus excavatum. It utilizes a subxyphoid incision with central fixation to maximize safe bar passage and minimize bar displacement.
Consecutive patients corrected with the modified Nuss procedure between 2010 and 2015 form the basis of this study.
During the study period, 73 patients had correction of their pectus excavatum by the modified Nuss procedure, utilizing subxyphoid incision and central fixation. Average age was 14.3 (range 8-19). 54 patients were male, 19 female. The average Haller index was 4.3 (range 3.2-7.2). No episodes of cardiac perforation, hemothorax or significant pneumothorax were recorded. Bar displacement occurred in two patients (2.7%) with one late recurrence after bar removal.
Our modification of the Nuss procedure is effective at preventing intrathoracic complications and cardiac perforation. Central fixation had a lower rate of bar displacement compared to published reports. Additional efforts are needed to further reduce bar displacement.
本研究回顾了我们之前所描述的用于矫正漏斗胸的微创（努斯）手术改良方法的结果。该方法采用剑突下切口及中央固定，以最大程度确保钢板安全置入并减少钢板移位。
2010年至2015年间接受改良努斯手术矫正的连续患者构成了本研究的基础。
在研究期间，73例患者通过采用剑突下切口及中央固定的改良努斯手术矫正了漏斗胸。平均年龄为14.3岁（范围8 - 19岁）。男性54例，女性19例。平均哈勒指数为4.3（范围3.2 - 7.2）。未记录到心脏穿孔、血胸或严重气胸事件。两名患者（2.7%）发生了钢板移位，其中一例在取出钢板后出现晚期复发。
我们对努斯手术的改良在预防胸腔内并发症和心脏穿孔方面是有效的。与已发表报告相比，中央固定的钢板移位率较低。需要进一步努力以进一步降低钢板移位。
