Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 63, Chicago, Illinois 60611-2605.
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 63, Chicago, Illinois 60611-2605.
J Pediatr Surg. 2019 Nov;54(11):2261-2267. doi: 10.1016/j.jpedsurg.2019.01.007. Epub 2019 Jan 23.
Objective preoperative assessment of pectus excavatum (PE) deformity in patients is limited to preoperative measurement of severity using computed tomography (CT) or magnetic resonance imaging (MRI). Postoperative assessment is currently subjective as postoperative CT scans are not recommended in light of radiation exposure and high cost to families. White Light Scanning (WLS) is a novel 3D imaging modality that offers an alternative that is a quick, nonionizing, inexpensive, and safe strategy for measurement both pre- and postsurgery. Our prior investigation demonstrated the feasibility of using WLS to measure PE deformity and showed very strong correlation of a new WLS-derived PE severity index, the Hebal-Malas Index (HMI), with CT-derived HI. The purpose of this study was to demonstrate use of WLS to assess extent of correction of PE deformities after the Nuss procedure.
WLS scan data were gathered prospectively in pediatric patients with PE from 2015 to 2018. HMI was obtained from the preoperative and postoperative WLS scans. Analysis assessed the differences of preoperative and postoperative HMI. Preoperative CT-derived HI was collected from the medical record and estimated postoperative Haller Index was calculated from HMI and correlation of HMI and HI using historical data.
A total of 71 patients received a preoperative CT scan and underwent surgery for PE. Of those, 63 (89%) received WLS preoperatively and 51 (72%) had complete preoperative and postoperative WLS data. The average postoperative decrease in the WLS-derived HMI was 0.35 (SD: 0.15) and 1.73 (SD: 1.03) in WLS-estimated HI.
WLS is highly effective in objectively quantifying the extent of surgical correction in PE patients.
IV TYPE OF STUDY: Diagnostic Study.
目前，对于漏斗胸（PE）畸形患者，术前评估仅限于使用计算机断层扫描（CT）或磁共振成像（MRI）进行严重程度的术前测量。由于存在辐射暴露和对家庭造成较高成本的问题，目前不推荐对术后 CT 扫描进行评估，因此术后评估目前是主观的。白光扫描（WLS）是一种新颖的 3D 成像方式，提供了一种快速、非电离、廉价且安全的策略，可在术前和术后进行测量。我们之前的研究表明，使用 WLS 测量 PE 畸形是可行的，并且新的 WLS 衍生的 PE 严重程度指数——He-bal-Malas 指数（HMI）与 CT 衍生的 HI 之间存在很强的相关性。本研究旨在证明 WLS 可用于评估 Nuss 手术后 PE 畸形的矫正程度。
前瞻性收集 2015 年至 2018 年间患有 PE 的儿科患者的 WLS 扫描数据。从术前和术后的 WLS 扫描中获取 HMI。分析评估了术前和术后 HMI 的差异。从病历中收集了术前 CT 衍生的 HI，并根据 HMI 计算了估计的术后 Haller 指数，并使用历史数据对 HMI 和 HI 进行了相关性分析。
共有 71 例患者接受了术前 CT 扫描并接受了 PE 手术。其中，63 例（89%）患者在术前接受了 WLS，51 例（72%）患者具有完整的术前和术后 WLS 数据。WLS 衍生的 HMI 的平均术后降低值为 0.35（标准差：0.15），WLS 估计的 HI 为 1.73（标准差：1.03）。
WLS 非常有效地客观量化了 PE 患者手术矫正的程度。
IV 型研究：诊断研究。
