Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Radiology, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Am Surg. 2024 Apr;90(4):631-639. doi: 10.1177/00031348231207296. Epub 2023 Oct 12.
Surgical correction of pectus excavatum (SCOPE) is dependent upon chest wall pliability with optimal timing prior to complete skeletal maturation. Measures of skeletal maturity are not readily available for operative planning; therefore, surgeons use age as proxy despite patient-specific rates of skeletal maturation. We aimed to determine whether preoperative skeletal maturity is associated with postoperative pain as surrogate for chest wall pliability.
Children ≤18 years who underwent SCOPE from 2020 to 2022 were retrospectively identified. Preoperative CT within 3 months of procedure was reviewed by 2 radiologists and 1 surgeon. Skeletal maturity was determined by Schmeling-Kellinghaus classification which stages secondary epiphyseal ossification of the medial clavicle. Inter-rater reliability was evaluated. Schmeling-Kellinghaus stage and postoperative pain were compared.
Of twenty-eight records reviewed, 57% were Schmeling-Kellinghaus stage 1. High inter-rater reliability was identified (inter-radiologist: kappa = .95, < .001, all raters: kappa = .78, < .001). Median age at operation was 15.5 years (interquartile range: 14.8-16.0) and increased with skeletal maturity ( < .001). When comparing stage 1 (n = 16) to >1 (n = 12), stage 1 had lower maximum pain scores ( < .001), total morphine equivalents ( < .001), and benzodiazepine use ( < .001) after surgery.
The Schmeling-Kellinghaus classification system is a valid proxy of skeletal maturity that can be applied with high inter-rater reliability. SCOPE during stage 1 was found to have less postoperative pain and narcotic use than more mature stages. This is proof of concept that skeletal maturity should be considered when determining optimal timing of surgical correction. Future research will evaluate the impact of skeletal maturity on postoperative outcomes.
漏斗胸（SCOPE）的手术矫正依赖于胸廓壁的柔韧性，最佳时机是在完全骨骼成熟之前。骨骼成熟度的测量方法不适用于手术规划；因此，尽管患者的骨骼成熟速度不同，外科医生仍使用年龄作为替代指标。我们旨在确定术前骨骼成熟度是否与术后疼痛相关，以作为胸廓壁柔韧性的替代指标。
回顾性地确定了 2020 年至 2022 年期间接受 SCOPE 的≤18 岁儿童。在手术前 3 个月内，由 2 名放射科医生和 1 名外科医生对术前 CT 进行了审查。骨骼成熟度由 Schmeling-Kellinghaus 分类确定，该分类分期了内侧锁骨的二次骺骨化。评估了观察者间的可靠性。比较了 Schmeling-Kellinghaus 分期和术后疼痛。
在审查的 28 份记录中，57%为 Schmeling-Kellinghaus 分期 1。观察者间的可靠性很高（放射科医生间：kappa =.95，<.001，所有观察者：kappa =.78，<.001）。手术时的平均年龄为 15.5 岁（四分位间距：14.8-16.0），并随骨骼成熟度而增加（<.001）。当比较 1 期（n = 16）与>1 期（n = 12）时，1 期的最大疼痛评分（<.001）、总吗啡当量（<.001）和苯二氮䓬类药物使用（<.001）较低。
Schmeling-Kellinghaus 分类系统是骨骼成熟度的有效替代指标，具有较高的观察者间可靠性。与更成熟的阶段相比，1 期的 SCOPE 术后疼痛和阿片类药物使用较少。这证明了概念，即骨骼成熟度应在确定手术矫正的最佳时机时考虑。未来的研究将评估骨骼成熟度对术后结果的影响。
