Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.
Surg Today. 2020 Oct;50(10):1249-1254. doi: 10.1007/s00595-020-02020-8. Epub 2020 May 26.
To establish whether new indices on plain chest X-ray (CXR) can replace those on computed tomography (CT) for the follow-up of children who have undergone the Nuss procedure.
The subjects of this retrospective study were 45 children who underwent the Nuss procedure between 2000 and 2016. The Haller index (HI) was measured by preoperative CT. Preoperative and postoperative chest deformities were evaluated by two CXR measurements: the concave rate on the lateral view (CR; the depth of the concavity divided by the anterior-posterior diameter of the rib cage) and the tracheal bifurcation angle (TBA) on the anterior view. Data are expressed as the median with range.
The median age and HI of the children, when they underwent the Nuss procedure, was 9.3 (3.8-17.3) years and 4.5 (3.2-10.1), respectively. The preoperative CR was correlated significantly with the HI. The postoperative CR was significantly lower than the preoperative CR [pre: 0.17 (0.08-0.37), post: 0.09 (0.01-0.18), p < 0.05], and the low value was sustained after bar removal. The TBA decreased significantly after the Nuss procedure from 74.2° (55-104) preoperatively to 65.0° (45-92) postoperatively (p < 0.05).
These results suggest that CXR can replace CT for the follow-up of patients after the Nuss procedure, with lower radiation exposure.
确定普通胸部 X 光（CXR）上的新指标是否可以替代 CT 上的指标，用于随访接受 Nuss 手术的儿童。
本回顾性研究的对象是 2000 年至 2016 年间接受 Nuss 手术的 45 名儿童。术前 CT 测量 Haller 指数（HI）。通过两次 CXR 测量评估术前和术后胸部畸形：侧位片上的凹陷率（CR；凹陷深度除以肋骨笼的前后直径）和前视图上的气管分叉角（TBA）。数据以中位数（范围）表示。
儿童接受 Nuss 手术时的中位年龄和 HI 分别为 9.3（3.8-17.3）岁和 4.5（3.2-10.1）。术前 CR 与 HI 显著相关。术后 CR 明显低于术前 CR[术前：0.17（0.08-0.37），术后：0.09（0.01-0.18），p<0.05]，且在移除外固定器后仍保持低值。Nuss 手术后 TBA 显著降低，从术前的 74.2°（55-104）降至术后的 65.0°（45-92）（p<0.05）。
这些结果表明，与 CT 相比，CXR 可以在辐射暴露较低的情况下，用于 Nuss 手术后患者的随访。
