Nuss手术后钢板移位的原因分析与预防及处理  

Causes analysis,prevention and management of bar displacement after Nuss procedure

作　　者：李瑶悦 马俊梅 蒋琴 陈芃螈 侯昉 徐冰 刘文英 Li Yaoyue;Ma Junmei;Jiang Qin;Chen Pengyuan;Hou Fang;Xu Bing;Liu Wenying(Department of Paediatric Surgery,Sichuan Provincial People′s Hospital,University of Electronic Science&Technology of China,Chengdu 610072,Sichuan Province,China)

机构地区：[1]电子科技大学附属医院·四川省人民医院小儿外科,成都610072

出　　处：《中华妇幼临床医学杂志（电子版）》2024年第2期224-230,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：四川省天府万人计划,天府名医项目(A.0101760);四川省科技厅重点项目(2021YFS0381);四川省医学科学院·四川省人民医院专项基金(2021ZX03)。

摘　　要：目的探讨Nuss手术后发生钢板移位的原因,总结预防及处理钢板移位措施。方法选择2010年6月至2022年2月四川省人民医院收治的Nuss手术后发生钢板移位的17例患者为研究对象。采用回顾性方法分析其临床病例资料,总结发生钢板移位的原因及处理措施等。本研究经四川省人民医院医学伦理委员会批准[审批文号:伦审(研)2023年第446号]。所有患者或其监护人对诊治均知情同意。结果①本组患者男性为15例、女性2例,年龄为(12.8±4.7)岁(5.5~25.3岁),Haller指数为3.6±0.3(3.3~4.3)。②本组17例患者中:14例为钢板上下倾斜移位、1例为钢板上下倾斜合并横向移位、2例为钢板向后陷入移位(年龄分别为25.3岁、18.3岁);非对称型漏斗胸患儿为13例,对称型为4例;年龄>12岁者为12例。③17例患者本次入院均再次手术调整钢板,均使用固定翼及医用不锈钢丝加固钢板。其中,2例为Nuss手术后>3个月发现钢板上下倾斜移位者,重新选择切口取出钢板后,更换肋间隙安置固定钢板;其余15例为Nuss手术后0~3个月内发现钢板移位者,经原切口更换肋间隙(4例)重新安置钢板或经原切口原肋间隙(11例)复位钢板后重新固定。④本组17例患者中,6例钢板安置位置不合适,8例在Nuss手术后确认或疑似有剧烈活动或外伤史,13例胸廓不对称,2例胸骨凹陷严重,12例年龄>12岁。结论漏斗胸患者Nuss手术时年龄适宜、钢板型号及放置位置合适、术后避免过早剧烈活动或外伤,是减少Nuss手术后钢板移位的主要措施。一旦发现Nuss术后钢板移位,应视具体情况及时纠正处理。Objective To explore the causes of bar displacement after minimally invasive orthopaedic Nuss procedure for pectus excavatum,and to summarise the preventive and treatment measures.Methods A total of 17 patients admitted to Sichuan Provincial People′s Hospital from June 2010 to February 2022 with bar displacement after Nuss procedure were selected into this study.Their clinical case data were retrospectively analysed to summarize the causes of bar displacement and its treatment measures.This study was approved by the Medical Ethics Committee of Sichuan Provincial People′s Hospital(Approval No.2023-46).Informed consents were obtained from all patients or their guardians.Results①The patients in this study were 15 males and 2 females,aged(12.8±4.7)years old(5.5-25.3 years old),with Haller index of 3.6±0.3(3.3-4.3).②Of the 17 patients in this study:14 cases had the bar flipping,1 case had the bar flipping combined with lateral sliding,and 2 cases had the dorsal shift of the bar(ages 25.3 and 18.3 years old,respectively);there were 13 cases of asymmetric pectus excavatum and 4 cases of symmetric type;and there were 12 patients whose age was>12 years old.③All 17 patients were reoperated to adjust the bar,and the bars were consolidate with stabilizer and medical stainless steel wire.Among them,2 cases were found to have bar flipping>3 months after Nuss procedure,and the fixed plate was placed by replacing the rib gap after selecting a new incision to take out the plate;the remaining 15 cases were found to have bar displacement within 0-3 months after Nuss procedure,and the bar was relocated by replacing the rib gap through the original incision(4 cases)or reset the bar through the original incision with the original rib gap(11 cases)and re-fixed.④Of the 17 patients in the study,6 cases had inappropriate bar placement,8 cases had confirmed or suspected history of strenuous activity or trauma after the Nuss procedure,13 cases had asymmetrical pectus excavatum,2 cases had severe sternal recess,and 12 cases wer

关 键 词：漏斗胸 NUSS 手术后并发症 钢板移位 病因 疼痛管理 

分 类 号：R726[医药卫生—儿科]