微创双板矫治漏斗胸的术中力学测量及影响因素  

Biomechanical Measurement During Operation and Its Influencing Factors for Pectus Excavatum Treated by Minimally Invasive Repair with Two Struts

作　　者：徐波[1] 刘吉福[1] 谭健[1] 叶金铎[2] 刘克强[1] 张春秋[2] 

机构地区：[1]北京军区总医院胸外科,北京100700 [2]天津理工大学生物力学研究所,天津300191

出　　处：《中国微创外科杂志》2014年第7期637-640,643,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然基金资助(11372221)

摘　　要：目的：探讨微创双矫形板矫治漏斗胸的生物力学及影响因素。方法2012年7月～2013年2月，连续对38例漏斗胸（儿童组和成人组各19例）行微创双矫形板矫治术。术前测量胸围、身高和体重；胸部CT扫描三维重建并测量漏斗胸指数（Haller index，HI）。用微创方法矫治，术中均使用2根矫形板；并用电子显示拉力计测量抬举胸骨单纯成形力、施压成形力和矫形板支撑压力，专用软件分析。结果38例用2根矫形板术中所测支撑胸壁的压力成人组高于儿童组，但仅有下板施压成形力[成人（207．2±37．0）N，儿童（175．2±36．8）N，t＝2．670，P＝0．011]和上板的矫形板压力[成人（75．1±21．9） N，儿童（60．6±13．7）N，t＝2．249，P＝0．020]，2组差异有显著性（P＜0．05）；2组组内比较上、下板压力差异均无显著性。成人组下板单纯成形力、施压成形力和上板施压成形力与胸围显著正相关（r＝0．545、0．681、0．581，P＝0．016、0．001、0．009），上板和下板单纯成形力、施压成形力与体重显著正相关（r＝0．504、0．704和0．483、0．614，P＝0．028、0．001和0．036、0．005）；而3个压力与身高无关。儿童组3个压力与身高、体重、胸围均无关。结论微创矫治漏斗胸术中胸廓成形力成人高于儿童，抬举胸骨压力强度与成人的胸围、体重有关。Objective To investigate biomechanical features and influencing factors of the pectus excavatum （ PE） repaired by minimally invasive surgery with two struts . Methods From July 2012 to February 2013, a total of 38 consecutive patients （19 cases of children and 19 cases of adults ） with PE were given minimally invasive surgery with two struts .Preoperatively , thoracic circumference, height, and body weight were measured , and the Haller index was recorded by thoracic three-dimensional CT reconstruction.The patients were corrected by minimally invasive surgery with two struts .The mechanics of the lifting merely the sternum forming, lifting and pressing forming, and the strut pressure were measured by electron display pull dynamometer during operation.The data were analyzed by the special-purpose software. Results The strut pressure during operation was more higher in the adult group than in the child group , but only pressing vis formative [adult （207.2 ±37.0） N, child （175.2 ±36.8） N, t=2.670, P=0.011] in the lower strut and the strut pressure [adult （75.1 ±21.9） N, child （60.6 ±13.7） N, t=2.249, P=0.020] in the upper strut existed had significant difference between the two groups （P〈0.05）.However, no significant difference was found between the lower and upper strut pressure in the same group .In the adult group , mechanics of the lifting merely the sternum forming, lifting and pressing forming on the lower strut , and lifting and pressing forming on upper strut were positively correlated to thoracic circumference （r=0.545, 0.681, 0.581;P=0.016, 0.001, 0.009）.The mechanics of the lifting merely the sternum forming, lifting and pressing forming on the lower and upper strut were positively correlated to body weight （ upper strut：r=0.504,0.704,P=0.028,0.001;lower strut：r=0.483,0.614,P=0.036,0.005）.The three forming mechanics were not correlated to height.In the child group, all three forming mechanics were not correlated to the thoracic circumference , body weight, or

关 键 词：漏斗胸 微创外科治疗 矫形力学 

分 类 号：R655[医药卫生—外科学]