ectus exeavatum is the most common chest wall deformity. The impairment of cardiopulmonaryfunction, severe psychological injury and other complications will be caused by the deformity. ″TheSternal Turnover″and″ The Sternal Elevation″are respective difference in indications andcharacteristics to treatment of pectus exeavatum. Pectus excavatum deformity will be repaired with theproper procedure and postoperative treatment. Their exercise tolerance and cardiac function will alsobe impro...
Pectus excavatum (PE) is a common congenital chest malformation in children, manifested by inward depression of the anteriorthorax wall, which can compress the normal tissues and organs in the chest and cause adverse effects on the physiology and psychology of patients. Surgery is the most important means of treating PE, and with the invention of Nuss surgery, the surgical treatment of PE has entered the minimally invasive era. At present, there are many indexes to evaluate the severity of thoracic malformations in PE patients, and selecting appropriate evaluation indexes is of great significance for the formulation of surgical protocols. As a physical and mental disease, PE's deformed thoracic appearance not only affects the function of thoracic organs, but also affects the psychological state of patients. Therefore, there is still controversy over whether the role of orthopedic surgery is to improve function or cosmetic plastic surgery. At the same time, the orthopedic efficacy and postoperative complications of the existing modified and novel surgical methods need to be further observed and evaluated. In addition, the design of surgical plan and the selection of surgical timing for PE combined with other diseases are also critical and controversial issues in clinical practice. Therefore, this article explores and reviews the controversial points in the current surgical treatment of PE.
Objective To review and investigate the compl ication and the treatment in Nuss procedure for correction of pectus excavatum. Methods From September 2005 to March 2009, 221 patients with pectus excavatum were treated withNuss procedure, including 189 males and 32 females and aging 2 years old and 10 months to 25 years old (median 8 years and 7 months old). Of 18 patients with recurrent pectus excavatum, 12 patients underwent a Ravitch procedure and the recurrence time of the depression after the first operation was less than 1 year in 2 patients, 1-3 years in 3, 3-5 years in 5, and over 5 years in 2; 6 patients underwent a stemotumover operation and the recurrence time of the depression after the first operation was less than 1 year in 2 patients, 1-3 years in 1 and 3-5 years in 3. The other 203 patients had a primary Nuss procedure, and the course of disease was from 18 months to 24 years. The preoperative CT scan showed the Haller index was 4.36 ± 1.34. Results The operation in all the patients were performed successfully without compl ications of death, massive hemorrhage and intrathoracic organ injury. The time of operation was 25-80 minutes (mean 40 minutes). The bleeding volume during procedure was 5-25 mL, with an average of 10 mL. Local allergy occurred in 3 cases after 7-10 months of operation, wound reject reaction in 2 cases after 3 and 11 months respectively, and effusion in 3 cases after 6-10 months; incision healed after dressing change. Incision healed primarly in the other patients. Pneumothorax occurred in 3 cases when the operation finished and in 7 cases after 2-4 days, pleural effusion in 4 cases after 3-5 days of operation, Nuss plate displacement in 2 cases after 3 days and 9 months, respectively. The patients having compl ication recovered well after treatment. The compl ication rate was about 8.72% (17/195). The followupperiod was 2-37 months for 195 patients. The postoperative Haller index was 2.52 ± 0.32 after 3 months of operation, showing statistically significant difference when compared with that before operation (P lt; 0.05). Conclusion Nuss procedure with non-thoracoscopic assistance for correction of pectus excavatum is safe because of less trauma and compl ication.
ObjectiveTo explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children.MethodsThe clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.ResultsA total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor.ConclusionMinimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.
ObjectiveTo summarize clinical experience of minimally invasive non-thoracoscopic Nuss procedure for the treatment of pectus excavatum (PE). MethodsFifty-one pediatric patients received minimally invasive nonthoracoscopic Nuss procedure for PE between July 2008 and February 2014 in Department of Thoracic Surgery, Jinan Military General Hospital. There were 32 males and 19 females with their average age of 8.32 (2.5-17.0) years. Transverse incisions were made in bilateral chest wall. Supporting plate was put to right chest wall through retrosternal approach, turned over and fastened onto the ribs. ResultsDeformity of all the patients was successfully corrected. Operation time was 30-52 (38±9) minutes. One patients had heart injury which was repair after open thoracotomy, and then supporting-plate was successfully secured. Postoperative complications included subcutaneous emphysema in 7 patients, pneumothorax in 3 patients and atelectasis in 3 patients, all of whom were cured by conservative treatment. Supportingplate transposition occurred in 1 patient and was corrected by reoperation. All the patients were followed up for 1-42 (21.6±7.6) months. According to Nuss standard, there were 39 patients with excellent results, 9 patients with good results, and 3 patients with fair results. ConclusionMinimally invasive Nuss procedure is an efficacious, easy, feasible and safe procedure for the treatment of PE with low morbidity.
ObjectiveTo summarize the clinical experience and investigate the safety and reliability of uniportal procedure for the correction of pectus excavatum (PE). MethodsFrom November 2010 to November 2015, 203 PE patients (164 males, 39 femalzs average age of 5.7±3.0 years, ranging from 2 to 19 years) underwent the correction operation with only single 2 cm incision on right lateral chest. There were 188 patients under 12 years of age and 15 patients above 12 years. According to Park classification, 176 patients were symmetric and 27 were asymmetric. ResultsAll operations were performed successfully. The average operating time was 16.1±5.2 min with a range of 4-65 min and the average postoperative hospital stay was 6.4±1.3 d, ranging from 4-14 d. A single incision was made on the right chest and only one bar was inserted in the patients. Postoperative follow-up was 1-56 months (mean, 27.6 months). There was no complication occurred such as bar turnover, displacement and redepressed sternum. Totally, 84 patients received bar removal procedure. ConclusionIn terms of operation time and surgical trauma, uniportal procedure for PE is superior to Nuss procedure. And there is no significant difference in the safety and effectiveness between two procedures. Uniportal procedure is especially suitable for the treatment of PE children under 12 years of age.
ObjectiveTo investigate the effect of anterior chest wall depression on the cardiac function and the effectiveness of minimally invasive surgery for pectus excavatum by comparing cardiac function and morphology between pre- and post-operation. MethodsBetween August 2009 and December 2010, 102 adult patients with pectus excavatum were treated with minimally invasive surgery, including the primary operation in 95 cases and the reoperation in 7 cases. There were 84 males and 18 females, aged 18-57 years (mean, 23.4 years). The haller index (HI) was 4.59 ± 1.51. Of 102 patients, 59 were classified as pectus excavatum type I and 43 as type II; 42 had clinical symptoms and 19 had the physical sign of heart. The preoperative chest CT examination showed cardiac compression in all patients and heart displacement in 74 patients. The left ventricular ejection fraction (LVEF) was 68.9% ± 6.2%. ResultsThe procedure was successful in all patients, and no death or serious complication occurred. The patients were followed up 12-28 months (mean, 21 months). The clinical symptoms and cardiac physical sign of the patients disappeared after operation. HI was 2.70 ± 0.33 at 12 months after operation, showing significant difference when compared with preoperative HI (t=5.83, P=0.00). According to Nuss’s evaluation method, the results were excellent in 99 patients and good in 3 patients. CT examination showed complete relief of cardiac compression in 101 patients and mild cardiac compression in 1 patient; the heart position was normal at 12 months after operation. Electrocardiogram returned to normal in 4 patients having abnormal electrocardiogram. LVEF was 70.5% ± 4.8% after operation, showing no significant difference when compared with preoperative LVEF (t=1.08, P=0.30). ConclusionThe main effects of pectus excavatum in adults on heart are compression and displacement. Cardiac compression may be relieved efficiently and the patient’s clinical symptoms can be abated by minimally invasive surgery.
ObjectiveTo develop a symptom and function assessment scale for patients after Nuss procedure for pectus excavatum and to test its reliability and validity. MethodsFollowing the principles and procedures of patient-reported outcome (PRO) scale development stipulated by the U.S. Food and Drug Administration, an initial draft was formed through literature analysis, qualitative interviews, and Delphi expert consultation. The preliminary draft was used to conduct a pre-survey on patients who underwent Nuss procedure for pectus excavatum at Guangdong Provincial People's Hospital, and the reliability and validity of the scale were tested. ResultsA preliminary PRO-based symptom and function scale was constructed, covering two domains: symptoms and impact on daily functions. The symptom dimension includes six items: chest tightness, palpitations, pain, shortness of breath, foreign body sensation of the steel plate, and distress; while the impact on daily functions includes four items: difficulty in getting out of bed or lying down, raising arms, bending over, and standing or sitting for a long time. A total of 73 patients who underwent Nuss procedure for pectus excavatum were included in the questionnaire survey, with 70 valid questionnaires collected, including 64 males and 6 females, with 56 patients aged 12-17 years and 14 patients≥18 years. Through exploratory factor analysis, two common factors were extracted, with a cumulative variance contribution rate of 70%. The Cronbach's α coefficient of the scale is 0.917. ConclusionThe scale developed in this study has good reliability and validity, high reliability and stability, and can be used as an evaluation tool for the recovery status of patients after Nuss procedure for pectus excavatum.
The surgical treatment of pectus excavatum has a history of more than 100 years, which has gone through from traditional open surgery to the current popular minimally invasive surgery. Nuss procedure, as the most classic minimally invasive operation, has been improved in accordance with the clinical needs since its inception to achieve fewer complications and better results, but there are still limitations that are difficult to break through, attracting a large number of scholars to make continuous innovation and develop updated devices and operation methods. This article reviews the history of funnel chest surgery, application and improvement of Nuss operation, double compression and complete fixation bar system and Wang procedure.
OBJECTIVE: To provide experimental basis for improving the curative effect of pectus excavatum. METHODS: Twelve rabbits were adopted in this experiment. After the bilateral second and third costal cartilages of the rabbits were resected subperichondrially, their right second and third costal perichondriums were damaged intentionally. Then, the bilateral third costal perichondriums were stitched into a tube-like structure and the second ones were left opened. After 2, 4, 6 of operation, the bilateral second and third neocartilages were measured for their width, and histological character were observed under microscope. RESULTS: 1. After 2, 4, 6 months of operation, the average width of the bilateral second neocartilages were significantly greater than the preoperative ones. 2. 4 and 6 months after operations, there was no significant difference in the average width of the bilateral third neocartilages and the preoperative ones. 3. The amount, distribution of costal neocartilage cells and the arrangement of costal neocartilage matrix within the left second and third costal cartilages were better than the right under the light microscope. 4. The left third costal neocartilage was regenerated and remodeled better than all the others. CONCLUSION: The integrality of costal perichondrium is in favor of the regeneration of costal cartilage, and the sleeve stitch of costal perichondrium facilitates the remodeling of costal neocartilage.