Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
J Pediatr Surg. 2024 Sep;59(9):1703-1707. doi: 10.1016/j.jpedsurg.2024.02.027. Epub 2024 Feb 29.
Costal cartilage resection with or without rib resection is the gold standard surgery for slipping rib syndrome. Minimally invasive restoration of normal anatomy via nonabsorbable sutures has been described in the adult population with encouraging results. We sought to assess the efficacy of minimally invasive sutured fixation of the hypermobile rib in the pediatric population.
A retrospective review was performed at Mayo Clinic involving 31 pediatric patients diagnosed with slipped rib syndrome. Minimally invasive sutured open reduction internal fixation was performed between 2020 and 2022. The standardized Örebro Musculoskeletal Pain Screening Questionnaire was given at dedicated time points pre- and post-operatively to assess efficacy. Significance was determined via the Wilcoxon rank sum test.
SRS was diagnosed clinically in 31 patients (24 females, 7 males, 1220 years-old). Symptoms were present for an average of 18.9 months and patients had seen an average of 4.7 specialists. Traumatic causes were identified in three patients and eight patients had hypermobility. At one month follow up, there were no surgical complications and patients reported significantly less pain (p < 0.001). Preoperative analgesics reduced by 80%. Ultimately, seven patients underwent a second operation; three patients underwent a third operation; one patient underwent five total operations. Recurrent pain was reported in six patients. Only nine patients followed-up at 1-year post-operation.
Pediatric patients with SRS demonstrated an early positive response to suture fixation without costal cartilage excision. Reoperation and recurrent pain, however, remain significant in this population.
Level IV.
Case series with no comparison group.
肋骨切除术联合或不联合肋软骨切除术是滑动肋综合征的金标准手术。已在成人人群中描述了通过不可吸收缝线微创恢复正常解剖结构，结果令人鼓舞。我们旨在评估微创缝线固定活动肋在儿科人群中的疗效。
对梅奥诊所的 31 例小儿滑动肋综合征患者进行回顾性研究。在 2020 年至 2022 年间，采用微创缝线切开复位内固定术。在术前和术后特定时间点使用标准化的Örebro 肌肉骨骼疼痛筛查问卷评估疗效。通过 Wilcoxon 秩和检验确定显著性。
31 例患者（24 例女性，7 例男性，12-20 岁）临床诊断为 SRS。症状平均出现 18.9 个月，平均就诊 4.7 次。3 例患者有创伤史，8 例患者存在过度活动。1 个月随访时，无手术并发症，患者疼痛明显减轻（p<0.001）。术前止痛药减少了 80%。最终，7 例患者再次手术，3 例患者第三次手术，1 例患者总共接受了 5 次手术。6 例患者报告复发疼痛。仅有 9 例患者在术后 1 年进行了随访。
SRS 患儿采用缝线固定术（不切除肋软骨）治疗，早期疗效显著。但在该人群中，再次手术和复发疼痛仍然是重要问题。
IV 级。
无对照组的病例系列研究。
