de Loos Erik R, Daemen Jean H T, Coorens Nadine A, Maessen Jos G, Vissers Yvonne L J, Hulsewé Karel W E
Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
Faculty of Health, Medicine and Life Sciences (FHML), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands.
JTCVS Tech. 2021 Jul 17;9:167-175. doi: 10.1016/j.xjtc.2021.05.028. eCollection 2021 Oct.
The crane technique is used to facilitate sternal elevation to provide safe mediastinal passage during the Nuss procedure. The aim was to objectively quantitate the elevation of the crane by 3-dimensional chest images acquired during the Nuss procedure.
A prospective cohort study was conducted. Patients undergoing the Nuss procedure were eligible. Sternal elevation was achieved by the crane technique providing a simultaneous lift of the anterior chest wall and reduction of the pectus excavatum depth. Both effects were evaluated. Three-dimensional surface images were acquired before incision, following sternal lift, and after bar implantation and quantitatively compared. Reduction of the external pectus excavatum depth was expressed as a percentage.
Thirty patients were included. Ninety percent were male, with a median age of 15.5 years (interquartile range [IQR], 14.5-17.4), Haller index of 3.56 (IQR, 3.09-4.65), and external pectus depth of 18 mm (IQR, 11-23). Sternal elevation by the crane provided a median 78% (IQR, 63-100) reduction of the deformity, corresponding with a residual depth of 3 mm (IQR, 0-7). The percentual reduction diminished with increasing depth of the sternal depression (correlation, -0.86). Besides reducing the deformity, the crane caused an elevation of the anterior chest over a large surface area with a maximum lift of 26 mm (IQR, 19-32).
The crane is an effective sternal elevation technique, providing 78% reduction of the sternal depression, although its effect lessens with increasing depth. In addition, it produces an elevation of the anterior chest over a large surface area.
在努斯手术中，采用吊臂技术来促进胸骨抬高，以确保纵隔通道安全。目的是通过在努斯手术过程中获取的三维胸部图像，客观量化吊臂的抬高情况。
进行了一项前瞻性队列研究。接受努斯手术的患者符合条件。通过吊臂技术实现胸骨抬高，同时抬高前胸壁并减少漏斗胸深度。对这两种效果均进行评估。在切口前、胸骨抬高后以及植入钢板后采集三维表面图像，并进行定量比较。漏斗胸外部深度的减少以百分比表示。
纳入30例患者。90%为男性，中位年龄15.5岁（四分位间距[IQR]，14.5 - 17.4），哈勒指数为3.56（IQR，3.09 - 4.65），外部漏斗胸深度为18 mm（IQR，11 - 23）。吊臂使胸骨抬高，畸形程度中位数减少78%（IQR，63 - 100），相应残余深度为3 mm（IQR，0 - 7）。畸形减少的百分比随胸骨凹陷深度增加而减小（相关性，-0.86）。除了减少畸形外，吊臂还使前胸在大面积上抬高，最大抬高26 mm（IQR，19 - 32）。
吊臂是一种有效的胸骨抬高技术，可使胸骨凹陷减少78%，尽管其效果随深度增加而减弱。此外，它还能使前胸在大面积上抬高。
