5170 Department of Surgery, University of Louisville, Louisville, KY, USA.
Am Surg. 2020 Dec;86(12):1672-1674. doi: 10.1177/0003134820940629. Epub 2020 Aug 17.
A small number of patients treated with minimally invasive correction of pectus excavatum recur after bar removal. This risk appears to be greater in younger children who continue to grow following bar removal.
We propose the use of wrist films to determine skeletal maturity and delay bar removal until it is completed. This is not possible in very young patients (less than 14 years of age) or necessary in patients older than 19.
In the 14-year to 18-year age group, we have used wrist films to determine skeletal maturity in 25 patients. Ten patients (age 14-18) demonstrated full maturation, and their bars were removed at 2 years. Five patients had films that demonstrated nearly closed growth plates, and those bars were removed 6 months later (2.5 years post-insertion). Ten patients had 2 sets of films taken, initially at 2 years post-operation demonstrating open growth plates. Films 12 months later showed skeletal maturation. Their bars were removed at 3 years post-operation. There were no recurrences with an average follow-up of 3 years.
Radiographic determination of skeletal maturity may be used as a guide to the timing of bar removal following the correction of pectus excavatum.
少数接受微创漏斗胸矫正治疗的患者在去除矫正器后会复发。对于在去除矫正器后仍继续生长的年幼儿童，这种风险似乎更大。
我们建议使用腕部 X 光片来确定骨骼成熟度，并在骨骼成熟后再去除矫正器。对于非常年幼的患者（<14 岁）或年龄大于 19 岁的患者，这是不可能的，也不是必需的。
在 14 岁至 18 岁的年龄组中，我们已经使用腕部 X 光片来确定 25 名患者的骨骼成熟度。10 名患者（年龄 14-18 岁）表现出完全成熟，他们的矫正器在 2 年后取出。5 名患者的 X 光片显示生长板几乎闭合，这些矫正器在 6 个月后（植入后 2.5 年）取出。10 名患者拍摄了 2 套 X 光片，最初在手术后 2 年显示生长板开放。12 个月后的 X 光片显示骨骼成熟。他们的矫正器在手术后 3 年取出。平均随访 3 年后无复发。
骨骼成熟的放射学确定可以作为漏斗胸矫正后去除矫正器时机的指导。
