漏斗胸患儿在手术治疗前后不同体型条件下身体垂直平衡的比较特征分析

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论证。目前，为全面理解漏斗胸患儿器官和系统多环节功能机制，研究不仅探讨胸廓的生物力学，也研究整体机体的生物力学。这有助于临床医生理解机体对胸廓畸形外科矫正所产生的多样化适应性反应。

目的。研究不对称型漏斗胸患儿在康复治疗不同阶段的姿势反应变化，并分析其与体质指数的关系。

方法。研究纳入两组13–16岁、男女兼有的左侧重度漏斗胸患儿，均接受临床影像学检查及稳定测量评估。第一组包括18例体型偏瘦患儿，其体质指数低于18.50 kg/m2。第二组包括15例体型正常患儿，其体质指数高于18.50 kg/m2且低于24.99 kg/m2。排除标准包括：超重患儿；右侧或对称型漏斗胸；合并其他胸廓畸形或胸腰段脊柱畸形及异常者。所有患儿均接受以矫正前胸壁畸形为目的的微创重建手术。对身体总压力中心及双足对侧压力中心运动参数进行分析，评估时间点为术前及术后 （平均2年）。所得数据与20名同龄、体质指数正常的健康儿童进行比较。

结果。术前稳定测量结果显示，两组患者均存在垂直平衡障碍，且在体型偏瘦患儿中表现更为明显。推测畸形胸骨对心包的压迫可改变来自其本体感受器的神经传入信号特征，从而引发姿势控制系统的改变。此外，两组患者在姿势策略方面存在差异，这可能影响垂直平衡的稳定性。术后，正常体型患儿的垂直平衡改善程度明显优于体型偏瘦患儿。平衡功能恢复质量分别为83%和78%（p=0.047）。这一结果可归因于不同体质指数患儿姿势控制系统适应能力的差异。在心包受压解除后，与体型偏瘦患儿相比，正常体型患儿本体感觉信号谱的变化可能引发姿势控制系统更为充分的调节反应。

结论。体质指数较低的漏斗胸患儿在接受微创矫形手术后，需采用个体化的康复治疗方案。该治疗策略旨在改善术后恢复过程，并促进姿势平衡的恢复与正常化。

作者简介

Igor Nikityuk

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: femtotech@mail.ru
ORCID iD: 0000-0001-5546-2729
SPIN 代码: 5901-2048

MD, Cand. Sci. (Medicine)
 
俄罗斯联邦, Saint Petersburg

Yuriy Garkavenko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: yurijgarkavenko@mail.ru
ORCID iD: 0000-0001-9661-8718
SPIN 代码: 7546-3080

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Dmitry Ryzhikov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dryjikov@yahoo.com
ORCID iD: 0000-0002-7824-7412
SPIN 代码: 7983-4270

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Bahauddin Dolgiev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dr-b@bk.ru
ORCID iD: 0000-0003-2184-5304
SPIN 代码: 2348-4418

MD

俄罗斯联邦, Saint Petersburg

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