儿童肋骨分叉畸形的临床诊治_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

秦廷江 , 杜明成 , 王朝辉 , 刘盈贝 , 何瑞靖 , 潘征夏 , 吴春 ,  安永

重庆医科大学附属儿童医院胸心外科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室（重庆 400014）;

Corresponding author：

安永, Email: incavnate@126.com

Keywords：

肋骨分叉; 诊断; 治疗

DOI：

10.7507/1007-4848.201605012

Video：

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目的探讨儿童肋骨分叉畸形的临床诊治经验，以期提高对该疾病的认识，降低漏诊和误诊的发生率。方法回顾性分析重庆医科大学附属儿童医院心胸外科 2011 年 4 月至 2015 年 4 月收治的 44 例肋骨分叉畸形患儿的临床资料，其中男 29 例、女 15 例，年龄 2.5～14.0（5.9±2.8）岁，均行手术治疗。分析总结临床特点、诊断、治疗方法和手术时机等。结果 44 例患儿中男女比例约为 2∶1；右侧畸形 32 例（72.7%），左侧畸形 10 例（22.7%），双侧多发畸形 2 例（4.5%），右左侧畸形比例约为 3∶1；右侧第 4 肋骨畸形有 15 例（34.1%），右侧第 5 肋骨畸形有 16 例（36.4%）；合并其他疾病者 13 例（29.5%）。其中 29 例采用畸形肋骨切除术，15 例采用畸形肋骨切除术和胸廓矫形术，术后病理均符合肋骨分叉畸形。术后随访 1～5 年，患者胸廓形态恢复良好，均无远期并发症发生。结论 CT 三维成像是肋骨分叉畸形诊断的有效辅助手段。肋骨分叉畸形一经确诊需密切随访，若发展较快或严重影响胸廓形态，推荐手术治疗，通过随访提示手术治疗效果良好。

Citation： 秦廷江, 杜明成, 王朝辉, 刘盈贝, 何瑞靖, 潘征夏, 吴春, 安永. 儿童肋骨分叉畸形的临床诊治. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 94-96. doi: 10.7507/1007-4848.201605012 Copy

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13.	Reidler JS, Das De S, Schreiber JJ, et al. Thoracic outlet syndrome caused by synostosis of the first and second thoracic ribs: 2 case reports and review of the literature. J Hand Surg Am, 2014, 39(12): 2444-2447.
14.	Derriks JH, Amaya JG, Steens J. Bifid rib: the importance of good radiological procedure. Ned Tijdschr Geneeskd, 2016, 160(0): D280.
15.	Kryger M, Kosiak W, Batko T. Bifid rib-usefulness of chest ultrasound. A case report. J Ultrason, 2013, 13(55): 446-450.

1. Kupeli E, Ulubay G. Bony bridge of a bifid rib. Cleve Clin J Med, 2010, 77(4): 232-233.
2. Mahajan PS, Hasan IA, Ahamad N, et al. A unique case of left second supernumerary and left third bifid intrathoracic ribs with block vertebrae and hypoplastic left lung. Case Rep Radiol, 2013, 2013: 620120.
3. Bijjaragi SC, Suragimath A, Sangle VA, et al. Gorlin goltz syndrome: A clinicopathological case report. J Indian Acad Oral Med Radiol, 2014, 26: 85-88.
4. Allwyn Joshua S, Shetty L, Pare VS, et al. Chondro-manubrial deformity and bifid rib, rare variations seen in pectus carinatum: a radiological finding. Surg Radiol Anat, 2013, 35(5): 443-447.
5. Ghandhari H, Tari HV, Ameri E, et al. Vertebral, rib, and intraspinal anomalies in congenital scoliosis: a study on 202 Caucasians. Eur Spine J, 2015, 24(7): 1510-1521.
6. Jain MK, Mahant S, Mahant PD, et al. VATER association with multiple ribs anomalies. J Assoc Physicians India, 2009, 57: 332-333.
7. Kaneko H, Kitoh H, Mabuchi A, et al. Isolated bifid rib: clinical and radiological findings in children. Pediatr Int, 2012, 54(6): 820-823.
8. Song WC, Kim SH, Park DK, et al. Bifid rib: anatomical considerations in three cases. Yonsei Med J, 2009, 50(2): 300-303.
9. Lata J, Verma N, Kaur A. Gorlin-Goltz syndrome: A case series of 5 patients in North Indian population with comparative analysis of literature. Contemp Clin Dent, 2015, 6(Suppl 1): S192-S201.
10. Donnelly LF, Taylor CN, Emery KH, et al. Asymptomatic, palpable, anterior chest wall lesions in children: is cross-sectional imaging necessary? Radiology, 1997, 202(3):829-831.
11. Yuce I, Sade R, Bayraktutan U, et al. Type II Klippel-Feil syndrome with accompanying rare costa deformity: rib fusion. Spine J, 2015, 15(9): 2088-2089.
12. Hines K, Graf E, Liu D, et al. The rare case of cervical rib fusion to the second rib. Ann Vasc Surg, 2014, 28(3): 742. e5-e8.
13. Reidler JS, Das De S, Schreiber JJ, et al. Thoracic outlet syndrome caused by synostosis of the first and second thoracic ribs: 2 case reports and review of the literature. J Hand Surg Am, 2014, 39(12): 2444-2447.
14. Derriks JH, Amaya JG, Steens J. Bifid rib: the importance of good radiological procedure. Ned Tijdschr Geneeskd, 2016, 160(0): D280.
15. Kryger M, Kosiak W, Batko T. Bifid rib-usefulness of chest ultrasound. A case report. J Ultrason, 2013, 13(55): 446-450.

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儿童肋骨分叉畸形的临床诊治

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