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1.
Ferdynand Hebal Elissa Port Catherine J. Hunter Bryan Malas Jared Green Marleta Reynolds 《Journal of pediatric surgery》2019,54(4):656-662
Background/purpose
Computed tomography (CT) derived Haller Index (HI) remains the standard for quantifying severity in patient with pectus excavatum (PE). Optical scanning described in literature reports optimistic results and new indices that correlate with HI. This study assessed the feasibility of a handheld White Light Scanner (WLS) to obtain 3D measurements and indices of PE deformity.Methods
From April 2015–April 2017, WLS scanning was conducted by orthotists during clinical visits. Included were children with PE up to 18?years. Analysis assessed correlation of a WLS-derived severity index, Hebal-Malas Index (HMI), with physician measured PE Depth (PED), and CT-derived HI.Results
Of 195 participants, 185(94%) patients with PE were scanned and 127(69%) had complete WLS data. For 88 patients undergoing monitoring, HMI correlated with PED (r?=?0.42, p?=?0.004). For 39 patients with pre-operative CT, HMI demonstrated strong correlation with HI (r?=?0.87, p < 0.0001).Conclusions
WLS demonstrated high feasibility of scanning PE. WLS-derived HMI best correlates with HI for patients with severe pectus deformity. Our current data is suggestive that WLS is best applied for severe deformities and yet to be established for milder deformities. Future yearly WLS will provide data on deformity progression and surgical therapy.Level of Evidence
IV.Type of Study
Diagnostic Study. 相似文献2.
Albert J. Moreno Allan L. Parker Peter Fredericks Gottlieb L. Turnbull 《European journal of nuclear medicine and molecular imaging》1986,12(5-6):309-310
A 58-year-old man with a pectus excavatum demonstrated a photon-deficient defect within the left lobe of the liver on liver-spleen scintigraphy using Tc-99m SCOL. Computed tomography of the liver clearly revealed the abnormal defect seen on the liver-spleen scan to be due to the pectus excavatum. This case confirms the impression that these skeletal aberrations may cause false-positive hepatic defects.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense 相似文献
3.
Chest Wall Implants: Their Use for Pectus Excavatum,Pectoralis Muscle Tears,Poland's Syndrome,and Muscular Insufficiency 总被引:3,自引:3,他引:0
Darryl J. Hodgkinson 《Aesthetic plastic surgery》1997,21(1):7-15
Solid customized and prefabricated silicone implants have been used by the author for 15 years in a wide range of chest wall
deformities. Chest wall implants are often used in males seeking to augment a muscularly deficient or underdeveloped chest;
however, their greatest use has come in a variety of deformities both congenital and acquired, such as pectus excavatum, Poland's
Syndrome, and pectoralis muscle tears. The implants can be either customized using a moulage technique or are prefabricated,
manufactured implants which can be modified on the operating table to repair the contour deformity. The immediate postoperative
problem of seroma and subcutaneous implant ``show' has been minimized by careful planning, gentle technique, deep insertion,
improved patient positioning on the operating room table, and the use of oral anti-inflammatory medications. The long-term
results of these implants seem very satisfactory. The patients are usualy physically active, and the implants show no long-term
sequelae such as seroma, infection, displacement, or rupture. 相似文献
4.
Reconstruction of pectus excavatum with silicone implants. 总被引:1,自引:0,他引:1
Alexander Margulis Mordechai Sela Rami Neuman Anat Buller-Sharon 《Journal of plastic, reconstructive & aesthetic surgery》2006,59(10):1082-1086
The pectus excavatum deformity is characterised by a deep depression usually involving the lower one-half to two-thirds of the sternum. The indications for surgery are often aesthetic. Extensive procedures, requiring fracturing and remodelling of the chest wall skeleton are associated with high morbidity and high rate of complications. In this article we describe our renewed experience with reconstruction of mild and moderate pectus excavatum deformities with custom made prefabricated silicone implants. The fabrication of the implant and the surgical technique are described in detail. An excellent aesthetic correction of the deformity was achieved in all of the patients in our series, with high patient satisfaction rate. We conclude that with careful patient selection, artistic implant fabrication and meticulous surgical technique, this approach achieves excellent aesthetic correction with minimal morbidity and a low complication rate and therefore should maintain its place in the armamentarium of surgical techniques for reconstruction of pectus deformities. 相似文献
5.
Pectusexcavatumisthemostfrequentanteriorchestwalldeformityandisproducedbyposteriordepressionofthesternumandlowercostalcartilage Itoccursmorecommonlyinboysbyalmosta 4∶ 1ratio Thesternumandcostalcartilagethatareangledposteriorlymaydecreasethechestvolume,r… 相似文献
6.
Brain R. West Harry Applebaum Bradford W. Edgerton 《Pediatric surgery international》1994,9(4):301-303
The most common approach to the pepair of pectus excavatum and pectus carinatum deformities is via a central transverse submammary incision. The subsequent suprasternal scar is conspicuous and prone to hypertrophic and keloid scarring. To avoid the keloid triangle and to produce a less noticeable scar, we have utilized bilateral inframammary incisions for repairs of five female and two male patients with pectus defects. This approach provides excellent access for cartilage resection, sternotomy, and sternal tupport without increasing opearative time or compromising operative exposure. On follow-up for up to 25 months, all patients have had excellent cosmetic and functional results. Chest wall configuration and stability, wound healing, and scar formation have all been without complication. No keloid or hypertrophic scars have developed. To date, there has been no recurrence of pectus defects. We believe bilateral inframammary incisions are a superior approach for pectus repairs by enchancing cosmesis with less noticeable scars and fewer hypertropic and keloid scars, all without compromising operative exposure or increasing operative time. 相似文献
7.
胸骨上举术的固定方式与结果 总被引:10,自引:0,他引:10
目的:分析胸骨上举术的不同固定方式与手术效果的关系。方法:148例经胸骨上举术治疗的漏斗胸患儿,术中分别用自制金属支杠、三点式悬吊和塑料及金属制成的支架背心悬吊固定胸骨。结果:其中84例患儿获术后6个月至6年(平均2年)随访观察,绝大部分效果满意,仅2例复发。27例保留金属支杠于术后10~12个月拔除者,无复发,外观更满意。结论:胸骨上举术治疗漏斗胸的效果肯定,手术安全。用自制金属支杠固定上举的胸骨操作简便,术后护理方便。保持金属支杠于手术后10~12个月才拔除,有利于防止复发,胸廓外形更满意。三点式悬吊固定对较小的轻度患儿适用。支架背心悬吊固定法术后护理不便,影响患儿日常生活,使用受限 相似文献
8.
《Clinical oncology (Royal College of Radiologists (Great Britain))》2021,33(12):e570-e577
AimsExposure of the heart to radiation increases the risk of ischaemic heart disease, proportionate to the mean heart dose (MHD). Radiotherapy techniques including proton beam therapy (PBT) can reduce MHD. The aims of this study were to quantify the MHD reduction achievable by PBT compared with volumetric modulated arc therapy in breath hold (VMAT-BH) in patients with pectus excavatum (PEx), to identify an anatomical metric from a computed tomography scan that might indicate which patients will achieve the greatest MHD reductions from PBT.Materials and methodsSixteen patients with PEx (Haller Index ≥2.7) were identified from radiotherapy planning computed tomography images. Left breast/chest wall, axilla (I–IV) and internal mammary node (IMN) volumes were delineated. VMAT and PBT plans were prepared, all satisfying target coverage constraints. Signed-rank comparisons of techniques were undertaken for the mean dose to the heart, ipsilateral lung and contralateral breast. Spearman's rho correlations were calculated for anatomical metrics against MHD reduction achieved by PBT.ResultsThe mean MHD for VMAT-BH plans was 4.1 Gy compared with 0.7 Gy for PBT plans. PBT reduced MHD by an average of 3.4 Gy (range 2.8–4.4 Gy) compared with VMAT-BH (P < 0.001). PBT significantly reduced the mean dose to the ipsilateral lung (4.7 Gy, P < 0.001) and contralateral breast (2.7 Gy, P < 0.001). The distance (mm) at the most inferomedial extent of IMN volume (IMN to heart distance) negatively correlated with MHD reduction achieved by PBT (Spearman's rho –0.88 (95% confidence interval –0.96 to –0.67, P < 0.001)).ConclusionFor patients with PEx requiring left-sided breast and IMN radiotherapy, a clinically significant MHD reduction is achievable using PBT, compared with the optimal photon technique (VMAT-BH). This is a patient group in whom PBT could have the greatest benefit. 相似文献
9.
10.