Abstract
Pectus excavatum (PEX) is the most common chest deformity in children, which is usually corrected by using the minimally invasive Nuss method. The orthopedic effect of the Nuss operation is mainly evaluated by both the Haller index and the appearance of the chest wall configuration, which is dependent on the operator’s clinical experience to a great extent. To improve the orthopedic effect, we proposed a novel method to individually design and optimize the shape of the Nuss bar and to advise its location as well as the incisions. By using the CT imaging data, the three-dimensional model of the PEX thoracic structure is reconstructed, which is further employed in finite element analysis to determine the operation plan. By referring to a healthy person who has similar chest dimensions to the PEX patient, the Nuss bar shape is designed, and according to the finding that the healthy chest wall boundary is almost convex with positive curvature, the Nuss bar shape is tuned to be a convex curve to ensure the orthopedic effect. Finite element analysis is employed to analyze the orthopedic effect and to determine the incision position of the Nuss bar. Experiments were carried out to verify the orthopedic effect of the customized Nuss bar, which showed that this method is more accurate and individualized, compared to conventional methods.
Highlights
Pectus excavatum (PEX) is the most common chest deformity in children, which is characterized by a depressed sternal region relative to the frontal rib cage[1]
Nuss bar has a high risk of failure due to poor stress distribution in pectus excavatum
The shape design and analysis of the Nuss bar are based on the thoracic structure of PEX patients, the first step to reconstruct the three-dimensional model of the thoracic structure is to use imaging data from a CT scan
Summary
Pectus excavatum (PEX) is the most common chest deformity in children, which is characterized by a depressed sternal region relative to the frontal rib cage[1]. Since the deformation of thoracic structure is very complicated, a Nuss procedure surgical planner would be an invaluable planning tool ensuring the optimal aesthetic outcome[9] This means that the location of the incisions and the shape of the Nuss bar are determined only by the physician with clinical experience. Mingyi Wang gave advice on restoring unilateral maxilla defects after simulating the defects in the maxillofacial model and reconstructing the model with different methods[16], where the finite element analysis to optimize prostheses surgery can be a good reference for the Nuss operation Both the shape of the Nuss bar and the stress distribution of the chest after implantation are of equal importance. Experiments using customized Nuss bars were carried out to validate the method in this paper
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