CAJ | 학술논문

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。
목적：탐토미창쌍교형판교치루두흉적생물역학급영향인소。방법2012년7월～2013년2월，련속대38례루두흉（인동조화성인조각19례）행미창쌍교형판교치술。술전측량흉위、신고화체중；흉부CT소묘삼유중건병측량루두흉지수（Haller index，HI）。용미창방법교치，술중균사용2근교형판；병용전자현시랍력계측량태거흉골단순성형력、시압성형력화교형판지탱압력，전용연건분석。결과38례용2근교형판술중소측지탱흉벽적압력성인조고우인동조，단부유하판시압성형력[성인（207．2±37．0）N，인동（175．2±36．8）N，t＝2．670，P＝0．011]화상판적교형판압력[성인（75．1±21．9） N，인동（60．6±13．7）N，t＝2．249，P＝0．020]，2조차이유현저성（P＜0．05）；2조조내비교상、하판압력차이균무현저성。성인조하판단순성형력、시압성형력화상판시압성형력여흉위현저정상관（r＝0．545、0．681、0．581，P＝0．016、0．001、0．009），상판화하판단순성형력、시압성형력여체중현저정상관（r＝0．504、0．704화0．483、0．614，P＝0．028、0．001화0．036、0．005）；이3개압력여신고무관。인동조3개압력여신고、체중、흉위균무관。결론미창교치루두흉술중흉곽성형력성인고우인동，태거흉골압력강도여성인적흉위、체중유관。
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 height. Conclusions The thoracic vis formative during PE repaired by minimally invasive surgery is higher in adults than in children .The pressure intensity of the sternum raised is correlated to thoracic circumference and body weight in adults .