Nuss 手术矫治漏斗胸的年龄分层结局:挑战年龄越小矫治效果越差的传统观点
Age-Stratified Outcomes of the Nuss Procedure for Pectus Excavatum: Challenging the Association Between Younger Age and Inferior Correction.
作者
作者单位
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: dr_lishuai@hust.edu.cn.
摘要
中文
本研究评估了 Nuss 术后不完全矫治的年龄特异性模式及影响因素,挑战了年龄越小复发风险越高的前提假设。回顾性分析 2006 至 2021 年接受 Nuss 手术的漏斗胸患者(拔除支撑棒后随访≥2 年)。按手术年龄分为:A 组(3-6 岁)、B 组(7-10 岁)、C 组(11-14 岁)和 D 组(≥15 岁)。比较围手术期参数与结局。共纳入 526 例患者,术前 Haller 指数随年龄增长而降低(P < .001)。年龄较大组手术时间延长、出血量增多、支撑棒使用增多、非致命性并发症发生率升高(均 P < .001)。总体不完全矫治率为 6.3%(33/526),虽初看随年龄变化(P = .049),但经多重比较校正后差异不再显著。各组表现时间不同:A 组拔棒后一年才延迟表现,D 组则于一个月内早期发现。2012 年引入的斜行支撑棒放置显著降低了最年轻组的不完全矫治率(从 12.2% 降至 3.3%,P = .020),其他组无显著影响。所有年龄组完全矫治病例均无恶化。年龄较小者术后并发症更少。不完全矫治率与年龄无关,但各组潜在机制各异。手术技术与器械的改进显著提高了完全矫治率。
English
This study evaluates age-specific patterns and factors influencing incomplete correction after the Nuss procedure, challenging the premise that younger age inherently increases recurrence. A retrospective review was conducted on patients who underwent the Nuss procedure for pectus excavatum (2006-2021), with a minimum follow-up of 2 years after bar removal. Patients were stratified by operative age: Group A (3-6 years), Group B (7-10 years), Group C (11-14 years), and Group D (≥15 years). Perioperative parameters and outcomes were compared. Among 526 patients, the preoperative Haller index decreased with age (P < .001). Older groups demonstrated increased operative time, blood loss, bar use, and non-life-threatening complication rates (all P < .001). While the 6.3% (33/526) incomplete correction rate initially varied by age (P = .049), risk disparities became non-significant following adjustment for multiple comparisons. Presentation timing differed, with Group A showing delayed presentation within one year post-removal versus early detection within one month for Group D. Oblique bar placement, introduced in 2012, significantly reduced incomplete correction in the youngest group (12.2% to 3.3%, P = .020), without significant effect on other groups. No deterioration occurred in complete correction cases among all age groups. Younger age was associated with fewer postoperative complications. Incomplete correction rate was not age-dependent, but the underlying mechanisms varied among groups. Modifications in surgical technique and instrumentation significantly improved the complete correction rate.
分类与指标
- 研究类型
- 临床研究
- 病种
- 气胸·外伤·胸壁
- JCR 分区
- Q1
- 影响因子
- 5.3