Nuss手术治疗漏斗胸患儿合并特发性脊柱侧弯的临床研究  

Clinical study of correcting scoliosis plus pectus excavatum with Nuss procedure in children

作　　者：曹隽[1] 张学军[1] 曾骐[1] 陈诚豪[1] 于洁[1] 郭东[1] 白云松[1] 祁新禹[1] 姚子明 冯磊[1] Cao Jun;Zhang Xuejun;Zeng Qi;Chen Chenghao;Yu Jie;Guo Dong;Bai Yunsong;Qi Xinyu;Yao Ziming;Feng Lei(Department of Surgery,Affiliated Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院,北京市100045

出　　处：《临床小儿外科杂志》2019年第1期13-17,共5页Journal of Clinical Pediatric Surgery

基　　金：北京市医院管理局"扬帆"计划临床技术创新项目(编号:XMLX201818)

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.

关 键 词：儿童 漏斗胸 NUSS手术 特发性脊柱侧弯 

分 类 号：R726.8[医药卫生—儿科] R681.5[医药卫生—临床医学]