漏斗胸Nuss矫形术对胸廓的影响及相关因素分析

目的通过CT影像测量了解漏斗胸Nuss矫形术前后胸廓径线的改变情况,探讨并分析Nuss矫形术对胸廓的影响及相关因素。方法对2014年1月至2018年12月郑州大学第一附属医院收治的50例行漏斗胸Nuss矫形术患儿的临床资料进行回顾性分析。50例患儿中男43例,女7例。所有患儿中存在脊柱侧弯6例,胸廓不对称12例,胸骨旋转11例。通过CT影像测量其放置矫形器前及取出矫形器后胸廓各椎体平面最大横内径及该平面胸脊间的距离,通过配对样本t检验比较矫形前后各径线的改变情况,以及通过独立样本t检验分析在不同年龄、性别、矫形时间、漏斗胸对称与否、是否合并脊柱侧弯等情况间的差异性。结果50例患儿均顺利完成矫形器置入术及矫形器拔除术,无明显术中及术后并发症,Nuss矫形后较矫形前相比,胸廓前后径在第8~12胸椎水平均较前增加,第3~5胸椎平面较前减小,胸廓横径在第8~10胸椎平面较前减小;年龄≤10岁、矫形时长≥2年及女性患儿胸廓前后径改变量在多个胸椎平面分别较年龄>10岁、矫形时长<2年及男性患儿大,P<0.05,差异具有统计学意义。结论漏斗胸Nuss矫形后前胸壁凹陷较前明显改善,并且在不同年龄和不同矫形时长间存在差异性,年龄较小及适当增加矫形时间可获得较好的矫形效果,而胸廓横径生长在一定程度上受限。

Impact of Nuss procedure on thoracic cavity and analysis of related factors

Objective To evaluate the impact of Nuss procedure by comparing the dimensional changes of thoracic cavity of pectus excavatum(PE)patients on computed tomography(CT)images.Methods A total of 50 PE cases undergoing Nuss procedure from January 2014 to December 2018 were selected.Retrospective reviews were performed for clinical data and CT examinations of chest.The anteroposterior and transverse diameters were measured at multiple thoracic vertebral levels.Paired-sample t-test was employed for comparing the differences between preoperative and postoperative parameters.And independent sample t-test was performed for comparing the inter-group differences in patient age,gender,insertion time of bar and type of PE.Results The postoperative anteroposterior diameters from T8 to T12 were significantly higher than their preoperative values while T3 to T5 anteroposterior diameters and T8 to T10 transverse diameters were lower than their preoperative values.In children aged under 10 years,the duration of bar placement time≥2 years and girl gender,the anteroposterior diameter changes were larger than the other groups at multiple vertebral levels(P<0.05)and the differences were statistically significant.Conclusions Anterior chest wall depression significantly improves after Nuss procedure.Early correction and longer correction time offer better corrective outcomes.The transverse diameter of thoracic cavity is somewhat limited in growth.