[1]侯昊,张学军,曹隽,等.漏斗胸合并脊柱侧凸的影像学特点及危险因素分析[J].临床小儿外科杂志,2023,22(06):511-516.[doi:10.3760/cma.j.cn101785-202211052-003]
　Hou Hao,Zhang Xuejun,Cao Jun,et al.Imaging characteristics and risk factors of pectus excavatum children with scoliosis[J].Journal of Clinical Pediatric Surgery,2023,22(06):511-516.[doi:10.3760/cma.j.cn101785-202211052-003]
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漏斗胸合并脊柱侧凸的影像学特点及危险因素分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第22卷 期数: 2023年06 页码: 511-516 栏目: 专题·儿童胸壁畸形的诊治 出版日期: 2023-06-28
Title:
Imaging characteristics and risk factors of pectus excavatum children with scoliosis
作者:
侯昊1;  张学军1;  曹隽1;  白云松1;  高荣轩1;  张瀚文1;  于洁2;  曾骐2
1. 国家儿童医学中心 首都医科大学附属北京儿童医院骨科, 北京 100045;
2. 国家儿童医学中心 首都医科大学附属北京儿童医院胸外科, 北京 100045
Author(s):
Hou Hao1;  Zhang Xuejun1;  Cao Jun1;  Bai Yunsong1;  Gao Rongxuan1;  Zhang Hanwen1;  Yu Jie2;  Zeng Qi2
1. Department of Orthopedics, Affiliated Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
2. Department of Thoracic Surgery, Affiliated Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
关键词:
漏斗胸; 脊柱侧凸; 放射摄影术; 危险因素
Keywords:
Funnel Chest; Scoliosis; Radiography; Risk Factors
DOI:
10.3760/cma.j.cn101785-202211052-003
摘要:
目的 探讨漏斗胸（pectus excavatum，PE）患儿中脊柱侧凸的发病情况及影像学特点，分析PE患儿合并脊柱侧凸的危险因素。方法 回顾性分析2017年12月至2022年2月于首都医科大学附属北京儿童医院就诊的575例PE患儿一般情况和影像学资料，统计PE患儿中脊柱侧凸的发病率及侧凸类型，采用两样本t检验和秩和检验比较存在脊柱侧凸的PE患儿与无脊柱侧凸PE患儿的一般情况及胸廓参数，采用Logistic回归分析PE患儿发生脊柱侧凸的危险因素。结果 575例PE患儿中，发生脊柱侧凸147例（147/575，25.6%），发生脊柱侧凸的PE患儿Cobb角为（14.50±4.01）°。70例（70/147，47.6%）存在单一胸弯，年龄较大（OR=1.894，P=0.003）和胸骨偏移中线程度较高（OR=1.728，P=0.034；OR=2.035，P=0.015）的患儿合并脊柱侧凸的风险更大。结论 PE患儿脊柱侧凸的发病率较高，年龄及胸骨偏移程度较大的PE患儿易合并脊柱侧凸。临床工作中需要关注PE患儿的脊柱发育情况，必要时进行早期干预。
Abstract:
Objective To explore the situation and imaging features of scoliosis in patients with pectus excavatum (PE) and examine the risk factors for combined scoliosis.Methods General profiles and imaging data were retrospectively reviewed for 575 PE children admitted from December 2017 to February 2022.The incidence and types of scoliosis were statistically examined.Two independent sample T and rank-sum tests were utilized for comparing general profiles and thoracic parameters of PE children with and without scoliosis.Binary logistic regression was utilized for examining the risk factors for combined scoliosis.Results A total of 147 patients with scoliosis were detected with an incidence of 25.6%.The mean Cobb angle was (14.50±4.01°).There were 70 cases (47.6%) with a single thoracic curve and scoliosis was more likely to occur in individuals with advanced age and greater distribution of offset coefficient.The incidence of scoliosis in PE children is higher than that in normal population, especially in elder children(OR=1.894, P=0.003) and those with greater distribution of offset coefficient(OR=1.728, P=0.034; OR=2.035, P=0.015).Conclusion The incidence of scoliosis in PE children is higher than that in normal children, especially in elder children and those with greater distribntion of offset coefficient.Clinicians should pay greater attention to spinal development and early interventions implemented if necessary.

参考文献/References:

[1] Park CH, Kim TH, Haam SJ, et al.Rib overgrowth may be a contributing factor for pectus excavatum:evaluation of prepubertal patients younger than 10 years old[J].J Pediatr Surg, 2015, 50(11):1945-1948.DOI:10.1016/j.jpedsurg.2015.07.010.
[2] Gokhale J, Selbst SM.Chest pain and chest wall deformity[J].Pediatr Clin North Am, 2009, 56(1):49-65.DOI:10.1016/j.pcl.2008.10.001.
[3] Fonkalsrud EW, De Ugarte D, Choi E.Repair of pectus excavatum and carinatum deformities in 116 adults[J].Ann Surg, 2002, 236(3):304-314.DOI:10.1097/00000658-200209000-00007.
[4] Nuss D, Kelly RE Jr.Indications and technique of Nuss procedure for pectus excavatum[J].Thorac Surg Clin, 2010, 20(4):583-597.DOI:10.1016/j.thorsurg.2010.07.002.
[5] Hanna WC, Ko MA, Blitz M, et al.Thoracoscopic Nuss procedure for young adults with pectus excavatum:excellent midterm results and patient satisfaction[J].Ann Thorac Surg, 2013, 96(3):1033-1038.DOI:10.1016/j.athoracsur.2013.04.093.
[6] Kelly RE, Goretsky MJ, Obermeyer R, et al.Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients[J].Ann Surg, 2010, 252(6):1072-1081.DOI:10.1097/SLA.0b013e3181effdce.
[7] Lo PC, Tzeng IS, Hsieh MS, et al.The Nuss procedure for pectus excavatum:an effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients[J].PLoS One, 2020, 15(5):e0233547.DOI:10.1371/journal.pone.0233547.
[8] Tis JE, Karlin LI, Akbarnia BA, et al.Early onset scoliosis:modern treatment and results[J].J Pediatr Orthop, 2012, 32(7):647-657.DOI:10.1097/BPO.0b013e3182694f18.
[9] Hong JY, Suh SW, Park HJ, et al.Correlations of adolescent idiopathic scoliosis and pectus excavatum[J].J Pediatr Orthop, 2011, 31(8):870-874.DOI:10.1097/BPO.0b013e31822da7d5.
[10] 曹隽, 张学军, 曾骐, 等.Nuss手术治疗漏斗胸患儿合并特发性脊柱侧弯的临床研究[J].临床小儿外科杂志, 2019, 18(1):13-17.DOI:10.3969/j.issn.1671-6353.2019.01.004. Cao J, Zhang XJ, Zeng Q, et al.Clinical study of correcting scoliosis plus pectus excavatum with Nuss procedure in children[J].J Clin Ped Sur, 2019, 18(1):13-17.DOI:10.3969/j.issn.1671-6353.2019.01.004.
[11] Waters P, Welch K, Micheli LJ, et al.Scoliosis in children with pectus excavatum and pectus carinatum[J].J Pediatr Orthop, 1989, 9(5):551-556.DOI:10.1097/01241398-198909010-00009.
[12] Kubota K, Doi T, Murata M, et al.Disturbance of rib cage development causes progressive thoracic scoliosis:the creation of a nonsurgical structural scoliosis model in mice[J].J Bone Joint Surg Am, 2013, 95(18):e130.DOI:10.2106/JBJS.L.01381.
[13] Zhong WH, Ye JD, Feng JJ, et al.Effects of pectus excavatum on the spine of pectus excavatum patients with scoliosis[J].J Healthc Eng, 2017, 2017:5048625.DOI:10.1155/2017/5048625.
[14] Tauchi R, Suzuki Y, Tsuji T, et al.Clinical characteristics and thoracic factors in patients with idiopathic and syndromic scoliosis associated with pectus excavatum[J].Spine Surg Relat Res, 2018, 2(1):37-41.DOI:10.22603/ssrr.2017-0027.
[15] Campbell RMJr, Smith MD, Mayes TC, et al.The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis[J].J Bone Joint Surg Am, 2003, 85(3):399-408.DOI:10.2106/00004623-200303000-00001.
[16] Liebsch C, Graf N, Appelt K, et al.The rib cage stabilizes the human thoracic spine:an in vitro study using stepwise reduction of rib cage structures[J].PLoS One, 2017, 12(6):e0178733.DOI:10.1371/journal.pone.0178733.
[17] Watkins R 4th, Watkins R 3rd, Williams L, et al.Stability provided by the sternum and rib cage in the thoracic spine[J].Spine (Phila Pa 1976), 2005, 30(11):1283-1286.DOI:10.1097/01.brs.0000164257.69354.bb.
[18] Cheng JC, Castelein RM, Chu WC, et al.Adolescent idiopathic scoliosis[J].Nat Rev Dis Primers, 2015, 1:15030.DOI:10.1038/nrdp.2015.30.
[19] Tomaszewski R, Wiktor ?, Macha?a L.Evaluation of thoracic vertebrae rotation in patients with pectus excavatum[J].Acta Orthop Traumatol Turc, 2017, 51(4):284-289.DOI:10.1016/j.aott.2017.03.005.
[20] 王运仓, 谢亮, 周海榆, 等.漏斗胸伴发扁平胸和脊柱侧弯的临床及影像学分析[J].中国临床医学影像杂志, 2011, 22(8):549-551.DOI:10.3969/j.issn.1008-1062.2011.08.005. Wang YC, Xie L, Zhou HY, et al.Imaging analysis of funnel chest coexisting with flat chest and scoliosis[J].J Chin Clin Med Imaging, 2011, 22(8):549-551.DOI:10.3969/j.issn.1008-1062.2011.08.005.
[21] Chang PY, Zeng Q, Wong KS, et al.A cross-sectional study of chest wall development in patients with pectus excavatum[J].Thorac Cardiovasc Surg, 2015, 63(5):433-436.DOI:10.1055/s-0034-1396928.
[22] Dimeglio A, Canavese F.Progression or not progression? How to deal with adolescent idiopathic scoliosis during puberty[J].J Child Orthop, 2013, 7(1):43-49.DOI:10.1007/s11832-012-0463-6.
[23] Wang YC, Chen G, Xie L, et al.Mechanical factors play an important role in pectus excavatum with thoracic scoliosis[J].J Cardiothorac Surg, 2012, 7:118.DOI:10.1186/1749-8090-7-118.
[24] Alexianu D, Skolnick ET, Pinto AC, et al.Severe hypotension in the prone position in a child with neurofibromatosis, scoliosis and pectus excavatum presenting for posterior spinal fusion[J].Anesth Analg, 2004, 98(2):334-335.DOI:10.1213/01.ANE.0000096187.58714.B6.
[25] Bafus BT, Chiravuri D, van der Velde ME, et al.Severe hypotension associated with the prone position in a child with scoliosis and pectus excavatum undergoing posterior spinal fusion[J].J Spinal Disord Tech, 2008, 21(6):451-454.DOI:10.1097/BSD.0b013e31815725f2.
[26] Park HJ, Kim JJ, Park JK, et al.Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum[J].J Thorac Dis, 2017, 9(10):3810-3816.DOI:10.21037/jtd.2017.08.128.

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备注/Memo

收稿日期:2022-11-27。
通讯作者:曹隽,Email:caojunhere@yeah.net

更新日期/Last Update: 1900-01-01