Вторинні порушення форми грудної клітки після корекції лійкоподібної деформації за методом Nuss

Abstract

Aim - studying the influence of the elasticity of the chest on the formation of secondary pectus carinatum and secondary protrusion of costal arches after Nuss procedure in order to determine the risk groups for the occurrence of data of secondary postoperative deformations in order to optimize a surgical intervention in these groups . Materials and methods. We analysed the data of 6 patients with pectus carinatum and 5 children with rib arches protrusion, which were formed as a result of Nuss funnel chest correction. The elasticity of the chest was studied by determining the ratio of its circumference during maximum inhalation and exhalation (mobility index - MI) as well as the ratio of the distance between the support plane in the supine position and the front surface of the chest in a neutral position and at the moment of compression (compliance index - CI). To calibrate the indicators, the data were calculated in a group of 30 healthy children. Depending on the obtained values, 3 degrees of chest elasticity are distinguished: high, medium and rigid chest. Results. 3 degrees of chest elasticity were determined in children without chest deformity: high (MI - 9.1±0.9%; CI - 28.1±1.8%), medium (MI - 6.8±0.2%; CI - 22.7±2.1%) and a low or rigid chest (MI - 4.9±0.2%; CI - 15.6±1.8%). The following data were recorded in patients with secondary deformities: 80% of patients with secondary pectus carinatum had a high degree of elasticity of the chest, 20% - average degree. In 83.33% of cases, patients with secondary rib arches protrusion had a high degree of elasticity of the chest, and 16.67% had an average degree. Secondary rib arches protrusion in 80% of cases is combined with the use of one horizontal bar. All cases of occurrence of secondary deformations are associated with a symmetric local type of funnel chest with or without deformations of costal arches or with an asymmetric local type. Conclusions. Using the Nuss operation technique with short plates in patients in the period of rapid growth with a high degree of elasticity of the chest with type IA and IIA1 of funnel chest can reduce the risk of secondary pectus carinatum; and in cases of high level risk of secondary protrusion of the rib arches the "flare buster" technique can help avoid this complication. The vast majority of secondary deformations are prone to spontaneous regression. The research was adhered to the principles of the Declaration of Helsinki. The research protocol was agreed by the Local Ethics Committee of the mentioned institution. The patients' informed consent was obtained for the study. No conflict of interests was declared by the authors.