小儿漏斗胸Nuss手术对胸廓影响的研究  

Biomechanical effects of Nuss procedure on thoracic wall of children with pectus excavatum

作　　者：杜国强[1] 张北叶 吴荣德[1] 马玉香 马睿[3] 于启海[1] 陈新国[1] 刘桂海[1] 

机构地区：[1]山东大学附属山东省立医院小儿外科,济南250021 [2]台北市长庚儿童医院小儿外科部 [3]山东省医学影像学研究所

出　　处：《中华小儿外科杂志》2009年第5期287-290,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨小儿漏斗胸Nuss手术对胸廓的影响。方法对2004年至2008年采用Nuss手术治疗的33例漏斗胸患儿，主要利用超声及螺旋CT检查进行术后随访。项目包括：肋骨、肋软骨、胸壁第1至第6对肋骨与软骨关节（CCJ）、胸肋关节（CSJ）以及胸廓外观。结果2例钢板移位；4例（12．1％）术后出现胸廓畸形；1例术后3年4个月发现右侧第四肋软骨胸骨端陈旧性骨折；1例术后1周发生右侧第五肋软骨横断骨折；8例（24．2％）术后近期随访发现不同程度的CSJ及CCJ的损伤；6例（18．2％）钢板平面以下的胸廓下陷；1例发现左侧第五肋软骨斑点状骨化。结论Nuss手术虽然优点颇多，但也存在明显不足。利用钢板的外力强行将凹陷的胸骨顶起，对胸廓是一种创伤，该创伤累及胸廓的关节、肋骨、肋软骨，使CSJ和CCJ不同程度分离、移位，肋软骨骨化、肋软骨骨折以及胸廓畸形等。Objective To evaluate the biomechanical effects of Nuss procedure on thoracic wall of children with pectus excavaturn. Methods From 2004 to 2008, 33 patients with pectus excavatum were followed up, who underwent Nuss procedure in this hospital. Ultrasonography and spiral CT were applied to evaluate the postoperative changes of ribs, costal cartilages, the first to the sixth costochondral joints （CCJ）, sternocostal joints （CSJ） and shape of chest walls. Results Nuss bar displacement was found in 2 cases. Postoperative bony thoracic protrusion was found in 4 （12. 1%） patients. One patient got obsolete fracture on the fourth dexter rib near the costochondral junction, which was detected by ultrasonography at 3 years and 4 months after the operation. Traverse fracture on the fifth dexter rib was found in one case at one week postoperatively. Injury on CSJ and CCJ was found in 8 cases （24. 2%） shortly after the operation. Dropping of bilateral costochondral junction below the Nuss bar was found in 6 （18. 2%） patients. Mottling ossification was found at the fifth sinister costal cartilage in 1 case. Conclusions Although the Nuss procedure has a great deal of advantages, it also brings some biomechanical damages to the chest wall. The trauma on chest wall which is caused by external force of Nuss bar involves CCJ, CSJ, ribs and costal cartilage, which can cause separation or displacement of CSJ or CCJ, ossification of costal cartilage, fracture of the ribs and anisotropy of the thoracic wall.

关 键 词：漏斗胸 胸肋关节 胸外科手术 

分 类 号：R686[医药卫生—骨科学]