Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy.
Department of Industrial Engineering, University of Florence, Florence, Italy.
Ann Thorac Surg. 2019 Apr;107(4):1253-1258. doi: 10.1016/j.athoracsur.2018.10.057. Epub 2018 Nov 30.
Pectus arcuatum is an anterior chest wall deformity that requires transverse wedge sternotomy. Determining and delivering the correct cutting angle are crucial for successful correction. This report describes the early clinical experience with a novel cutting template technology able to deliver the optimal cutting angle.
From patients' computed tomographic scans, the optimal cutting angle is obtained using computer-aided design. A template comprising slots tilted at the right cutting angle and a safety block to avoid damaging the posterior periosteum is printed through additive manufacturing.
The template allows surgeons to perform a precise wedge sternotomy, safely sparing the posterior periosteum in all patients, without complications. Postoperative chest roentgenograms and clinical photographs demonstrate optimal sternal realignment and cosmetic outcome. In this report, the mean operative time was 110 minutes. All patients were successfully discharged, with a mean length of stay of 4 days.
Transverse wedge sternotomy aided by a computer-aided design-devised cutting template may reduce the technical challenge of this procedure, thereby increasing its safety and reducing operative times and hospital stay. Further research on long-term patient outcomes is necessary.
鸡胸是一种前胸部壁畸形，需要进行横楔形胸骨切开术。确定并提供正确的切割角度对于成功矫正至关重要。本报告介绍了一种新型切割模板技术的早期临床经验，该技术能够提供最佳的切割角度。
从患者的计算机断层扫描中，使用计算机辅助设计获得最佳切割角度。通过增材制造打印出一个模板，该模板包括以正确切割角度倾斜的狭槽和一个安全块，以避免损伤后骨膜。
该模板可使外科医生精确地进行楔形胸骨切开术，在不引起并发症的情况下，安全地保护所有患者的后骨膜。术后胸部 X 光片和临床照片显示胸骨的最佳矫正和美容效果。本报告中，平均手术时间为 110 分钟。所有患者均成功出院，平均住院时间为 4 天。
计算机辅助设计设计的切割模板辅助的横楔形胸骨切开术可能降低该手术的技术难度，从而提高其安全性，并减少手术时间和住院时间。需要进一步研究长期患者的预后。
