Pretorius E S, Haller J A, Fishman E K
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Clin Imaging. 1998 Mar-Apr;22(2):108-16. doi: 10.1016/s0899-7071(97)00073-9.
Pectus excavatum is the most common congenital chest wall deformity. Extensive corrective surgery prior to age 3 may disturb chest wall growth and result in a constricted thorax. We describe our surgical and radiologic experience with eight such cases, paying particular attention to the role of spiral computed tomography (CT) with 3D reconstruction in patient management. Spiral CT was performed on children who had developed restrictive chest walls following pectus excavatum surgery. These children then underwent a unique operation to elevate the sternum and attempt to correct their restrictive chest wall defects. In several cases, postoperative spiral CT was performed. Spiral CT with 3D reconstruction defined the orientation of the ribs and costal cartilages and their relationship to the sternum, allowing exact preoperative measurement of the bony rib cage and guiding individualized operative correction. Computed thoracic volumes in select cases correlated well with subjective patient reports of increased exercise capacity. Repair of pectus excavatum defects prior to age 3 may result in constrictive thoracic abnormalities. Surgical correction can increase thoracic volume and improve prospects for normal thoracic function. Three-dimensional reconstruction of spiral CT data is useful in both preoperative and postoperative evaluation.
漏斗胸是最常见的先天性胸壁畸形。3岁前进行广泛的矫正手术可能会干扰胸壁生长并导致胸廓狭窄。我们描述了8例此类病例的手术和放射学经验，特别关注螺旋计算机断层扫描（CT）三维重建在患者管理中的作用。对漏斗胸手术后出现限制性胸壁的儿童进行螺旋CT检查。这些儿童随后接受了一项独特的手术，抬高胸骨并试图纠正其限制性胸壁缺陷。在几例病例中，术后进行了螺旋CT检查。螺旋CT三维重建确定了肋骨和肋软骨的方向及其与胸骨的关系，允许术前精确测量骨性胸廓并指导个体化手术矫正。部分病例中计算的胸廓容积与患者主观报告的运动能力增强情况相关性良好。3岁前修复漏斗胸缺损可能会导致限制性胸廓异常。手术矫正可增加胸廓容积并改善胸廓正常功能的前景。螺旋CT数据的三维重建在术前和术后评估中均有用。
