CAJ | 학술논문

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.
목적 탐토소인루두흉Nuss수술대흉곽적영향.방법 대2004년지2008년채용Nuss수술치료적33례루두흉환인,주요이용초성급라선CT검사진행술후수방.항목포괄:륵골、륵연골、흉벽제1지제6대륵골여연골관절(CCJ)、흉륵관절(CSJ)이급흉곽외관.결과 2례강판이위;4례(12.1%)술후출현흉곽기형;1례술후3년4개월발현우측제사륵연골흉골단진구성골절;1례술후1주발생우측제오륵연골횡단골절;8례(24.2%)술후근기수방발현불동정도적CSJ급CCJ적손상;6례(18.2%)강판평면이하적흉곽하함;1례발현좌측제오륵연골반점상골화.결론 Nuss수술수연우점파다,단야존재명현불족.이용강판적외력강행장요함적흉골정기,대흉곽시일충창상,해창상루급흉곽적관절、륵골、륵연골,사CSJ화CCJ불동정도분리、이위,륵연골골화、륵연골골절이급흉곽기형등.
Objective To evaluate the biomechanical effects of Nuss procedure on thoracic wall of children with pectus excavatum.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 ioints (CCJ),sternocostal joints (CSJ) and shape of chest walls.Resuits 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.Iniury 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 ESJ or EEJ,ossification of costal cartilage,fracture of the ribs and anisotropy of the thoracic wall.