BROAD PECTUS EXCAVATUM TREATMENT: LONG TERM RESULTS OF A BRAZILIAN TECHNIQUE

ABSTRACT Objective: This study aims the treatment results of broad pectus excavatum after a long-term follow-up and skeletal maturity. Methods: Eighty-four children and adolescents with broad-type pectus excavatum were selected for evaluation after treatment with a dynamic orthosis that applies compression to the lower rib projections and prescription of exercises. The broad pectus excavatum was defined as a deformity that the depressed area was greater and covered the area above and below the nipple line. All patients were evaluated for more than 1 year after the end of treatment and skeletal maturity. Post-treatment results were categorized as mild, moderate and severe. Statistic correlations between results and deformity flexibility, deformity severity, and adherence to treatment were assessed. Results: The mean age at the beginning of treatment was 13.3 years, and the follow-up duration was 25.7 months after suspension of orthosis use. Forty-eight percent of patients showed good results. With regular use of orthoses and performance of exercises, this rate increased to 70% (p < 0,001). Mild cases showed more success than severe cases (p = 0,007). Initial flexibility didn’t influence the results (p = 0,63). Conclusion: Treatment of broad pectus excavatum with orthoses and exercises led to good definitive results in most resilient patients, especially in those with mild deformities. Level of Evidence V, Expert Opinion.

摘要
研究目的：本研究旨在探讨宽型漏斗胸（broad pectus excavatum）经长期随访及骨骼成熟后的治疗效果。
研究方法：选取84例宽型漏斗胸儿童及青少年患者，采用针对下肋骨凸起施加压迫的动态矫形器（dynamic orthosis）结合运动处方进行治疗。宽型漏斗胸被定义为凹陷区域范围更广，覆盖乳头线上下区域。所有患者均在治疗结束后随访超过1年且确认骨骼成熟。将治疗后效果分为轻度、中度及重度三级。分析治疗效果与畸形柔韧性、畸形严重程度及治疗依从性之间的统计学相关性。
研究结果：患者开始治疗时的平均年龄为13.3岁，停用矫形器后的随访时长为25.7个月。48%的患者获得良好治疗效果。若能规律使用矫形器并完成运动训练，该比例可提升至70%（p<0.001）。轻度畸形患者的治疗成功率显著高于重度畸形患者（p=0.007）。初始畸形柔韧性对治疗效果无显著影响（p=0.63）。
研究结论：采用矫形器结合运动训练治疗宽型漏斗胸，可在多数依从性良好的患者中获得良好的远期疗效，尤其适用于轻度畸形患者。本研究证据等级为V级，属于专家意见。