Nuss手术治疗漏斗胸患儿合并特发性脊柱侧弯的临床研究
|
摘要
目的了解漏斗胸患儿合并特发性脊柱侧弯的发病情况及经Nuss手术治疗后脊柱侧弯的改变情况。方法以2011至2013年于首都医科大学附属北京儿童医院接受胸外科手术治疗并符合纳入标准的171例漏斗胸患儿为研究对象,患儿入院后行CT检查了解漏斗胸情况,并分别于Nuss手术前及取出钢板后行胸部及脊柱X线检查了解脊柱侧弯情况;对比脊柱侧弯与非侧弯患儿的胸骨旋转度、胸廓旋转度、Haller指数等指标,同期对比胸廓对称与非对称患儿的脊柱侧弯改变情况。结果171例漏斗胸患儿中合并脊柱侧弯的比例为21. 1%(36/171),平均Cobb角16. 9°;侧弯患儿与非侧弯患儿Haller指数无统计学差异(P> 0. 05),但胸骨旋转度及胸廓旋转度均显著大于非侧弯患儿(P <0. 05);侧弯患儿根据弯度给予相应治疗(侧弯<25°的患儿继续随诊观察,侧弯在25°～45°且骨骼发育未成熟的患儿要求佩戴支具,侧弯> 45°的患儿予以手术治疗);中位随访时间为35. 73个月,随访过程中,13例原脊柱正常患儿出现脊柱侧弯,14例患儿原脊柱侧弯消失;胸廓不对称患儿脊柱侧弯出现变化的比例显著高于胸廓对称的患儿(P <0. 05)。结论漏斗胸患儿易合并特发性脊柱侧弯,Nuss手术治疗后其脊柱侧弯程度可能发生改变,需要小儿胸外科医生与小儿骨科医生共同协作治疗。
Objective To evaluate the prevalence and progression of idiopathic scoliosis plus pectus excavatum after Nuss procedure. Methods A total of 171 pectus excavatum cases were retrospectively reviewed.Chest and spinal radiographic films were taken before Nuss procedure and after bar removal. Several parameters including thoracic kyphosis,sternum rotation,thoracic rotation,thoracic asymmetric ratio and Haller index were compared between scoliosis and non-scoliosis groups. Also the changes of scoliosis were compared between symmetric and asymmetric chest groups. Results The prevalence of scoliosis plus pectus excavatum was 21. 1%( 36/171) with an average Cobb's angle of 16. 87°. In scoliosis group,there were higher values of sternal and thoracic rotation( P < 0. 05) and no difference existed between Haller index. The scoliosis patients were treated as observation/brace/surgery due to their curve angle. The follow-up period was 35. 73 months. After bar removal,14 cases improved to normal while another 13 normal cases progressed to scoliosis. Scoliosis change occurred more likely in asymmetric chest patients( P < 0. 05). Conclusion There is a high prevalence of idiopathic scoliosis in pectus excavatum patients. And scoliosis may change after Nuss procedure. Pediatric chest and orthopedic surgeons should cooperate closely.
Objective To evaluate the prevalence and progression of idiopathic scoliosis plus pectus excavatum after Nuss procedure. Methods A total of 171 pectus excavatum cases were retrospectively reviewed.Chest and spinal radiographic films were taken before Nuss procedure and after bar removal. Several parameters including thoracic kyphosis,sternum rotation,thoracic rotation,thoracic asymmetric ratio and Haller index were compared between scoliosis and non-scoliosis groups. Also the changes of scoliosis were compared between symmetric and asymmetric chest groups. Results The prevalence of scoliosis plus pectus excavatum was 21. 1%( 36/171) with an average Cobb's angle of 16. 87°. In scoliosis group,there were higher values of sternal and thoracic rotation( P < 0. 05) and no difference existed between Haller index. The scoliosis patients were treated as observation/brace/surgery due to their curve angle. The follow-up period was 35. 73 months. After bar removal,14 cases improved to normal while another 13 normal cases progressed to scoliosis. Scoliosis change occurred more likely in asymmetric chest patients( P < 0. 05). Conclusion There is a high prevalence of idiopathic scoliosis in pectus excavatum patients. And scoliosis may change after Nuss procedure. Pediatric chest and orthopedic surgeons should cooperate closely.
引文
1 Fokin AA,Steuerwald NM,Ahrens WA,et al.Anatomical,histologic,and genetic characteristics of congenital chest wall deformities[J].Semin Thoracic Cardiovasc Surg,2009,21(1):44-57.DOI:10.1053/j.semtcvs.2009.03.001.
2 Brochhausen C,Turial S,Müller FK,et al.Pectus excavatum:history,hypotheses and treatment options[J].Interact Cardiovasc Thorac Surg,2012,14(6):801-806.DOI:10.1093/icvts/ivs045.
3 Shamberger RC.Congenital chest wall deformities[J].Current Problems in Surgery,1996,33(6):469-542.
4 Ravitch MM.Pectus excavatum and heart failure[J].Surgery,1951,30(1):178.
5 Jr KR,Lawson ML,Paidas CN,et al.Pectus excavatum in a 112-year autopsy series:anatomic findings and the effect on survival[J].Journal of Pediatric Surgery,2005,40(8):1275-1278.
6 Park JM,Varma SK.Pectus excavatum in children:diagnostic significance for mitral valve prolapse[J].Indian Journal of Pediatrics,1990,57(2):219-222.
7 Waters P,Welch K,Micheli LJ,et al.Scoliosis in children with pectus excavatum and pectus carinatum[J].J Pediatr Orthop,1989,9(5):551-556.
8 Niedbala A,Adams M,Boswell WC,et al.Acquired thoracic scoliosis following minimally invasive repair of pectus excavatum[J].Am Surg,2003,69(6):530-533.
9 Tardie GB,Dorsey DA,Kaeferlein BH.Evaluation of unexplained dyspnea in a young athletic male with pectus excavatum[J].J Sports Sci Med,2005,4(3):323-331.
10 Yeh YC,Yang CC,Tai CL,et al.Characterization of a novel caudal vertebral interbody fusion in a rat tail model:An implication for future material and mechanical testing[J].Biomedical Journal,2017,40(1):62-68.
11 Goldberg CJ,Fogarty EE,Moore DP,et al.Scoliosis and developmental theory:adolescent idiopathic scoliosis[J].Spine,1997,22(19):2228.
12 Jr CR,Smith MD,Mayes TC,et al.The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis[J].Journal of Bone&Joint Surgery American Volume,2003,85(3):399.
13 Kelly RE,Goretsky MJ,Obermeyer R,et al.Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients[J].Annals of Surgery,2010,252(6):1072.
14 Hoksch B,Kocher G,Vollmar P,et al.Nuss procedure for pectus excavatum in adults:long-term results in a prospective observational study[J].Eur J Cardiothorac Surg,2016,50(5):934-939.DOI:10.1093/ejcts/ezw130.
15 Sacco Casamassima MG,Gause C,Goldstein SD,et al.Patient Satisfaction After Minimally Invasive Repair of Pectus Excavatum in Adults:Long-Term Results of Nuss Procedure in Adults[J].Annals of Thoracic Surgery,2016,101(4):1338-1345.DOI:10.1016/j.athoracsur.2015.09.102.
16 Zhang DK,Tang JM,Ben XS,et al.Surgical correction of 639 pectus excavatum cases via the Nuss procedure[J].Journal of Thoracic Disease,2015,7(9):1595.DOI:10.3978/j.issn.2072-1439.2015.09.30.
17 Rainey JW,David F,Sunil S.Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum[J].Journal of Cardiothoracic Surgery,2014,9(1):25.DOI:10.1186/1749-8090-9-25.
18 Tis JE,Karlin LI,Akbarnia BA,et al.Early onset scoliosis:,modern treatment and results[J].Journal of Pediatric Orthopaedics,2012,32(7):647.DOI:10.1097/BPO.0b013e3182694f18.
19 Park CH,Kim TH,Haam SJ,et al.Asymmetric Pectus Excavatum Is Associated with Overgrowth of Ribs Rather Than Cartilage[J].Thoracic&Cardiovascular Surgeon,2014,63(5):427-432.DOI:10.1055/s-0034-1395394.
20 Raso VJ,Lou E,Hill DL,et al.Trunk distortion in adolescent idiopathic scoliosis[J].J Pediatr Orthop,1998,18(2):222.DOI:10.1097/00004694-199803000-00017.
21 Redding GJ,Mayer OH.Structure-Respiration Function Relationships Before and After Surgical Treatment of Early-onset Scoliosis[J].Clin Orthop Relat Res,2011,469(5):1330-1334.DOI:10.1007/S11999-010-1621-0.
22 Nagasao T,Noguchi M,Miyamoto J,et al.Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum[J].J Thorac Cardiovasc Surg,2010,140(6):1294-1299.DOI:10.1016/j.jtcvs.2010.06.025.
23 Tomaszewski R,Wiktor,Machaa L.Evaluation of thoracic vertebrae rotation in patients with pectus excavatum[J].Acta Orthop Traumatol Turc,2017,51(4):284-289.DOI:10.1016/j.aott.2017.03.005.
2 Brochhausen C,Turial S,Müller FK,et al.Pectus excavatum:history,hypotheses and treatment options[J].Interact Cardiovasc Thorac Surg,2012,14(6):801-806.DOI:10.1093/icvts/ivs045.
3 Shamberger RC.Congenital chest wall deformities[J].Current Problems in Surgery,1996,33(6):469-542.
4 Ravitch MM.Pectus excavatum and heart failure[J].Surgery,1951,30(1):178.
5 Jr KR,Lawson ML,Paidas CN,et al.Pectus excavatum in a 112-year autopsy series:anatomic findings and the effect on survival[J].Journal of Pediatric Surgery,2005,40(8):1275-1278.
6 Park JM,Varma SK.Pectus excavatum in children:diagnostic significance for mitral valve prolapse[J].Indian Journal of Pediatrics,1990,57(2):219-222.
7 Waters P,Welch K,Micheli LJ,et al.Scoliosis in children with pectus excavatum and pectus carinatum[J].J Pediatr Orthop,1989,9(5):551-556.
8 Niedbala A,Adams M,Boswell WC,et al.Acquired thoracic scoliosis following minimally invasive repair of pectus excavatum[J].Am Surg,2003,69(6):530-533.
9 Tardie GB,Dorsey DA,Kaeferlein BH.Evaluation of unexplained dyspnea in a young athletic male with pectus excavatum[J].J Sports Sci Med,2005,4(3):323-331.
10 Yeh YC,Yang CC,Tai CL,et al.Characterization of a novel caudal vertebral interbody fusion in a rat tail model:An implication for future material and mechanical testing[J].Biomedical Journal,2017,40(1):62-68.
11 Goldberg CJ,Fogarty EE,Moore DP,et al.Scoliosis and developmental theory:adolescent idiopathic scoliosis[J].Spine,1997,22(19):2228.
12 Jr CR,Smith MD,Mayes TC,et al.The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis[J].Journal of Bone&Joint Surgery American Volume,2003,85(3):399.
13 Kelly RE,Goretsky MJ,Obermeyer R,et al.Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients[J].Annals of Surgery,2010,252(6):1072.
14 Hoksch B,Kocher G,Vollmar P,et al.Nuss procedure for pectus excavatum in adults:long-term results in a prospective observational study[J].Eur J Cardiothorac Surg,2016,50(5):934-939.DOI:10.1093/ejcts/ezw130.
15 Sacco Casamassima MG,Gause C,Goldstein SD,et al.Patient Satisfaction After Minimally Invasive Repair of Pectus Excavatum in Adults:Long-Term Results of Nuss Procedure in Adults[J].Annals of Thoracic Surgery,2016,101(4):1338-1345.DOI:10.1016/j.athoracsur.2015.09.102.
16 Zhang DK,Tang JM,Ben XS,et al.Surgical correction of 639 pectus excavatum cases via the Nuss procedure[J].Journal of Thoracic Disease,2015,7(9):1595.DOI:10.3978/j.issn.2072-1439.2015.09.30.
17 Rainey JW,David F,Sunil S.Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum[J].Journal of Cardiothoracic Surgery,2014,9(1):25.DOI:10.1186/1749-8090-9-25.
18 Tis JE,Karlin LI,Akbarnia BA,et al.Early onset scoliosis:,modern treatment and results[J].Journal of Pediatric Orthopaedics,2012,32(7):647.DOI:10.1097/BPO.0b013e3182694f18.
19 Park CH,Kim TH,Haam SJ,et al.Asymmetric Pectus Excavatum Is Associated with Overgrowth of Ribs Rather Than Cartilage[J].Thoracic&Cardiovascular Surgeon,2014,63(5):427-432.DOI:10.1055/s-0034-1395394.
20 Raso VJ,Lou E,Hill DL,et al.Trunk distortion in adolescent idiopathic scoliosis[J].J Pediatr Orthop,1998,18(2):222.DOI:10.1097/00004694-199803000-00017.
21 Redding GJ,Mayer OH.Structure-Respiration Function Relationships Before and After Surgical Treatment of Early-onset Scoliosis[J].Clin Orthop Relat Res,2011,469(5):1330-1334.DOI:10.1007/S11999-010-1621-0.
22 Nagasao T,Noguchi M,Miyamoto J,et al.Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum[J].J Thorac Cardiovasc Surg,2010,140(6):1294-1299.DOI:10.1016/j.jtcvs.2010.06.025.
23 Tomaszewski R,Wiktor,Machaa L.Evaluation of thoracic vertebrae rotation in patients with pectus excavatum[J].Acta Orthop Traumatol Turc,2017,51(4):284-289.DOI:10.1016/j.aott.2017.03.005.