Schulz-Drost Stefan, Luber Anna Maria, Simon Kirsten, Schulz-Drost Melanie, Syed Julia, Carbon Roman T, Besendörfer Manuel
Department of Pediatric Surgery, University Hospital Erlangen, Erlangen, Germany.
Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany.
J Thorac Dis. 2018 Oct;10(10):5736-5746. doi: 10.21037/jtd.2018.09.148.
Complex and mature funnel chest deformities are traditionally managed with open surgical procedures. Elastic stable chest repair (ESCR) has been used successfully and safely for relapse corrections. Does pure plate osteosynthesis in ESCR allow comparable corrective potency and implant safety as hybrid methods with metal bars?
Data from 86 patients with open funnel chest correction between 2011 and 2015 were analyzed in this retrospective study. Exclusion criteria included being under 12 years of age, and having a history of septic wound healing disorder or other malignant diseases. Main groups consisted of ESCR and hybrid techniques, subgroups were primary and recurrence correction. Correction results and follow-up examinations at six and 12 weeks and at 1 year were statistically analyzed.
A total of 38 ESCR and 48 hybrid methods were analyzed. Bar implantation was required in 77% (recurrence 34%) of patients. All patients received plates with different combinations e.g., longitudinal-sternal, costosternal and costo-sterno-costal. In all groups, follow-up uptake showed a funnel chest correction result at the anatomical level with healthy values according to the Haller index (ESCR 4.36-2.84, hybrid 6.99-2.74, P<0.001). No material dislocations were observed in any subgroup.
ESCR and hybrid techniques represent promising and safe therapeutic approaches.
复杂且成熟的漏斗胸畸形传统上采用开放手术治疗。弹性稳定胸廓修复术（ESCR）已成功且安全地用于复发矫正。ESCR中的单纯钢板接骨术与使用金属棒的混合方法相比，是否具有相当的矫正效力和植入安全性？
本回顾性研究分析了2011年至2015年间86例行开放性漏斗胸矫正术患者的数据。排除标准包括年龄在12岁以下、有感染性伤口愈合障碍病史或其他恶性疾病史。主要分组包括ESCR和混合技术，亚组包括初次矫正和复发矫正。对矫正结果以及6周、12周和1年时的随访检查进行了统计学分析。
共分析了38例ESCR和48例混合方法。77%的患者需要植入金属棒（复发率34%）。所有患者均接受了不同组合的钢板，如纵向胸骨、肋胸骨和肋-胸-肋组合。在所有组中，随访结果显示漏斗胸在解剖学水平上得到矫正，根据哈勒指数，矫正结果均处于健康范围（ESCR组从4.36降至2.84，混合技术组从6.99降至2.74，P<0.001）。任何亚组均未观察到材料移位。
ESCR和混合技术是有前景且安全的治疗方法。
