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成人漏斗胸微创矫治后胸廓骨重塑与临床疗效观察
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成人漏斗胸微创矫治后胸廓骨重塑与临床疗效观察
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Journal Article
成人漏斗胸微创矫治后胸廓骨重塑与临床疗效观察
2012
Overview
目的探讨成人漏斗胸微创矫形后胸廓骨的重塑变化与临床疗效。方法选择漏斗胸患者82例,男67例,女15例,年龄18～57（23.5±6.1）岁,对称型（Ⅰ型）37例,非对称型（Ⅱ型）45例,漏斗胸指数（HI）3.2～11.8（3.98±2.96）。所有患者均在全麻下行两侧腋中线切口,胸腔镜监视下将制备好的支撑杆置入胸骨后（1根60例,2根22例）。术前和术后1周行胸部CT扫描三维重建胸廓影像,在矢状位上以胸椎体中心线为切线位,测量胸骨与胸椎体前缘之间的距离,并观察心脏移位情况。结果使用1根矫形杆矫形后胸骨体中部及下端分别前移8.69、15.69mm,与术前比较差异有统计学意义（P〈0.01）,而胸骨体上端及胸骨柄上、下端分别前移2.39、-2.38、1.44mm,与术前比较差异无统计学意义。使用2根矫形杆矫形后胸骨柄下端及胸骨体上端、中部、下端分别前移10.8、12.45、17.61、20.62mm,与术前比较差异有统计学意义（P〈0.01）,而胸骨柄上端前移2.34mm,与术前比较差异无统计学意义。CT扫描显示矫形后心脏恢复正常位置。使用2根矫形杆者胸廓外观优于使用1根者。结论微创矫治成人漏斗胸时矫形杆的支撑力可使胸骨重塑成形;使用1根或2根矫形杆时胸骨的重塑变化规律及力学作用不同。
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