Scoring of Deformed Costal Cartilages Reduces Postoperative Pain after Nuss Procedure for Pectus Excavatum
Scoring of Deformed Costal Cartilages Reduces Postoperative Pain after Nuss Procedure for Pectus Excavatum
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DOI：
10.1055/s-0035-1552924
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发表时间：
2015-07
影响因子：
1.5
通讯作者：
T. Nagasao;Yusuke Hamamoto;Motoki Tamai;Tetsukuni Kogure;Hua Jiang;N. Takano;Yoshio Tanaka
中科院分区：
文献类型：
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作者：
T. Nagasao;Yusuke Hamamoto;Motoki Tamai;Tetsukuni Kogure;Hua Jiang;N. Takano;Yoshio Tanaka
摘要目的本研究旨在阐明畸形软骨评分是否能减轻漏斗胸患者Nuss手术后的疼痛。方法46例漏斗胸患者行Nuss手术。患者被分成两组，根据是否在Nuss手术的基础上进行了软骨畸形评分辅助操作。对畸形肋软骨进行评分的患者分为评分组(n=24)，未评分的患者分为无评分组(n=22)。通过有限元动态模拟计算胸椎最大应力后，进行组间最大von-Mise应力值比较。此外，在将术后疼痛量化为患者在术后2天内通过硬膜外疼痛控制系统注射麻醉药的频率后，比较两组患者的疼痛程度。结果非计分组胸腔最大应力明显大于计分组，注药频率非计分组明显高于计分组(平均4.9次/2d)。结论Nuss术式会产生较高的应力值，引起术后疼痛。可以通过对变形的软骨进行补充评分来减少应力。因此，术后疼痛减轻。
Abstract Objective The present study aims to elucidate whether or not scoring deformed cartilages reduces postoperative pain after the Nuss procedure for pectus excavatum patients. Methods A total of 46 pectus excavatum patients for whom the Nuss procedure was conducted were included in the study. The patients were categorized into two groups, depending on whether or not the supplementary maneuver of scoring deformed cartilages was performed in addition to the Nuss procedure. Patients for whom deformed costal cartilages were scored were categorized as the Scoring Group (n = 24); those who received no such scoring were categorized as the Non-Scoring Group (n = 22). After evaluating the maximum stresses occurring on the thoraces by means of dynamic simulation using finite element analyses, intergroup comparison of the maximum von-Mises stress values was performed. Furthermore, after quantifying postoperative pain as the frequency with which patients injected anesthetics through an epidural pain-control system within 2 postoperative days, the degree of pain was compared between the two groups. Results The maximum stresses occurring on the thorax were significantly greater for the Non-Scoring Group than for the Scoring Group; injection frequency was also greater for the Non-Scoring Group (average 4.9 times for 2 days) than for the Scoring Group (average 2.5 times for 2 days). Conclusion High stresses occur due to the performance of the Nuss procedure, causing postoperative pain. The stresses can be reduced by performing supplementary scoring on deformed cartilages. Accordingly, postoperative pain is reduced.