Nuss钢板矫治鸡胸的效果观察和思考

目的研究一种鸡胸矫治的微创方法并观察近期效果。方法经胸壁隆起最高处做一水平线,双侧腋前线至腋中线间区域相邻两条肋骨间沿水平线各做一长约3 cm切口,保持胸壁最高点与双侧切口在一条线上,并沿连线在骨性胸壁外做肌肉下隧道并与双侧切口相通。双侧切口下方用钢丝经骨膜下将固定片平行于身体纵轴固定于上下相邻肋骨。选取适配的Nuss钢板,钢板大小预先经过测量。调整形状后的钢板由预先做好的肌肉下隧道置入。连接钢板与固定片钢丝固定,将隆起的胸壁下压恢复平坦。患者手术当天及术后第1天床上活动,做挺胸动作及咳嗽;术后2～3 d可逐步恢复下床活动。结果 3例均未进胸膜腔,无需置管引流。手术矫形效果满意。术后疼痛程度为中度,术后4～5 d停用止痛药。结论采用肋骨外Nuss钢板置入微创矫治鸡胸技术上安全可行,手术创伤小,切口美观,对心肺功能影响小,矫形效果满意,值得进一步研究推广。

Observation and thinking of Nuss steel plate for treatment of pectus carinatum

Abstract]ObjectiveTo explore a promising minimally invasive operation for repairing pectus carinatum and to observe the early effects of it. MethodsA virtual line perpendicular to the longitudinal axis of the body was drew through the peak of the chest wall deformity. The positions of bilateral incision between preaxillary line and midaxillary line were determined in each side along the virtual line. Muscles under incisions were dissected to expose ribs. Subpectoral tunnel connecting two incisions along the virtual line was made. The fixation plates were firmly bound with steel wire via subperiosteum to consecutive ribs lengthways ensuring that subsequent horizontally placed Nuss bar can be favourably suited to them. The size and suitable length of Nuss bar was carefully chosen between two fixation plates crossing the anterior thoracic wall. Keeping truncus straight and initiative cough were encouraged in early days and out of bed activity were needed 2-3 days after operation. ResultsNo pleural cavity intrude case occurred and no chest tube needed. The effects of the correction were satisfied in all 3 patients. The average level of postoperative pain was among midrange and no analgesic administrated during 4-5 days after operations. ConclusionIt was secure and feasible to correct pectus carinatum using Nuss bar via extra sternum tunnel. Minimal invasion, shorter incision, less influence to heart and pulmonary function and satisfying correcting effects were achieved.