Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School.
Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School.
J Pediatr Surg. 2021 Oct;56(10):1835-1840. doi: 10.1016/j.jpedsurg.2021.01.027. Epub 2021 Jan 27.
We report pectus carinatum management over a 10+year period.
Staged management, with initial bracing and operation for failure or special circumstances, was employed. A newer brace and a minimally invasive operation for PC (the Abramson procedure) were introduced during the study period.
Of 695 consenting patients from 2008 to 2018, 265 (38%) were observed. Of 430 treated, 339 (79%) had bracing only; 65 (15%) underwent surgery without a trial of bracing, while 26(5%) underwent surgery after a failed attempt at bracing. Of 364 bracing patients, 144 (40%) were successful, 77 (21%) are ongoing, 25 (7%) failed, and 118 (32%) dropped out. Recurrence was noted in 17 (5%), an average 5.4 months later. Two (0.4%) overcorrected to pectus excavatum (PE). Successful patients experienced a 50% decrease in pressure of correction (POC) beginning one month after starting treatment. Brace failure patients did not. Reported compliance with brace utilization (hours/day) was similar. Surgery was required in 91 patients. Open operations were performed in 61 (67%), Abramson operations in 23 (25%), and Nuss procedure in 7 (8%) who developed excavatum over correction following bracing or who had mixed deformity, with excavatum one side of the sternum and carinatum on the other. Twenty-four (36%) of the surgeries for PC occurred after an attempt at bracing. All obtained good initial results by operation. No recurrence was noted after open operation and 3 (13%) after Abramson. Open complications included 1 (2%) infection. Abramson's operation required 11 (48%) revisions, 6 (26%) early bar removals, and had 3 (13%) infections.
Brace treatment for PC can be guided by pressure of correction, which fell by more than half in successfully treated patients. POC did not fall in patients who failed. If POC does not fall, surgery should be considered. Open repair of Pectus Carinatum is generally successful, while the Abramson operation has a significant rate of complications with the implants currently available in the U.S.
Level III - Retrospective comparative study.
我们报告了 10 多年来鸡胸畸形的治疗情况。
采用分期治疗，初始采用支具治疗，对于失败或特殊情况则采用手术治疗。在研究期间，我们引入了一种新型支具和一种微创鸡胸畸形手术（Abramson 手术）。
在 2008 年至 2018 年间，共有 695 名患者同意参与研究，其中 265 名（38%）接受了观察。在 430 名接受治疗的患者中，339 名（79%）仅接受了支具治疗；65 名（15%）未经过支具治疗尝试直接接受了手术治疗，而 26 名（5%）则在支具治疗失败后接受了手术治疗。在 364 名接受支具治疗的患者中，144 名（40%）治疗成功，77 名（21%）仍在治疗中，25 名（7%）治疗失败，118 名（32%）退出治疗。17 名（5%）患者出现复发，平均复发时间为 5.4 个月。有 2 名（0.4%）患者矫正过度至漏斗胸（PE）。治疗开始后一个月，成功患者的压力矫正（POC）下降了 50%。而支具治疗失败的患者 POC 没有下降。报告的支具使用依从性（每天小时数）相似。91 名患者需要手术治疗。61 名（67%）患者接受了开放手术，23 名（25%）患者接受了 Abramson 手术，7 名（8%）患者因支具治疗后出现凹陷或存在混合畸形（一侧胸骨凹陷，另一侧胸骨凸起）而接受了 Nuss 手术。24 名（36%）患者在尝试支具治疗后进行了 PC 手术。所有手术患者均获得了良好的初始效果。开放手术后未出现复发，Abramson 手术后有 3 例（13%）复发。开放手术并发症包括 1 例（2%）感染。Abramson 手术需要 11 次（48%）修正，6 次（26%）早期去除支具，有 3 例（13%）感染。
PC 的支具治疗可以根据压力矫正（POC）来指导，成功治疗的患者 POC 下降超过一半。而支具治疗失败的患者 POC 没有下降。如果 POC 没有下降，则应考虑手术治疗。鸡胸畸形的开放修复通常是成功的，而目前在美国使用的 Abramson 手术植入物存在较高的并发症发生率。
III 级-回顾性比较研究。
