Thoracic Deformity Research Articles

Wenlin index of pectus excavatum

Pectus excavatum is a common thoracic deformity. There are many clinical indicators to evaluate its severity, among which Haller index is the most commonly used one. However, this index has many defects. In order to eliminate these defects, we designed a new index, namely Wenlin index. This index is the normalized depression depth, which is an ideal value because it can directly reflect the degree of depression. We believe that if this value is used together with Haller index, the severity of pectus excavatum can be evaluated more comprehensively.

Operation of Wenlin chest

Wenlin chest is a rare thoracic deformity, which is characterized by protrusive upper chest wall and depressed lower middle chest wall, and the root cause of the deformty is the thickening and deformation of sternum. Because the sternum is too hard, the normal sandwich technique cannot correct this deformity. We have made a special name for this deformity and designed operations for it. We performed pre-shaping on the sternum at first, and then implemented Wenlin procedure and Wang procedure for correction and achieved satisfactory results. The operation of a 28-year-old Wenlin chest patient was reported in this article.

Wang procedure: Background, characteristics and application

Wang procedure is a new method to treat pectus excavatum. Before this operation, there was almost only one choice for the treatment of pectus excavatum, which was Nuss procedure. Nuss procedure is a great operation. However, due to obvious defects, improvement is needed. Since general improvement cannot eliminate some deep-rooted defects, the only way to completely eliminate these defects is to design a brand-new technique. It is against this background that Wang procedure came into being. A large number of clinical practices have shown that this operation not only has many advantages that Nuss procedure does not have, but also can be used in a variety of depression and complex deformities. The appearance of Wang procedure has completely changed the concept of thoracic deformity correction and promoted the progress of technology.

The highest level of surgical treatment of pectus excavatum

Pectus excavatum is the most common thoracic deformity, and there are many surgical methods used in clinic. Almost all the previous operations were limited to one kind of procedure. The completion of the operation will directly affect the effect of the treatment of pectus excavatum. After long-term clinical practice, we found that pectus excavatum can be treated with multiple methods at the same time. The use of these methods can completely correct the deformity and achieve the most satisfactory results. Thus, we have a new understanding of the treatment of this deformity. The treatment level of pectus excavatum itself is not the same as the level of mastering a certain surgical method. The highest level of pectus excavatum surgery is to make the most perfect treatment for this deformity, and it is absolutely not to skillfully complete a certain operation.

Application of MatrixRIB in the operation of secondary thoracic deformity caused by empyema

Empyema is an ancient and serious thoracic infectious disease. In the early years, this disease was more common. With the wide application of highly effective antibiotics, this disease has been very rare. However, in some remote areas, the disease is still common. Empyema is a kind of intrathoracic lesion, but it can affect the chest wall, leading to secondary depression and scoliosis. In the past, the treatment of empyema was mainly to remove the lesions in the chest, and no one dealt with the chest wall deformity. This is an obvious defect of previous operations. Considering the harm of chest wall deformity, we think it is necessary to correct the deformity. After the removal of intrathoracic lesions, we used MatrixRIB to reconstruct the chest wall, and achieved satisfactory results. This paper introduces the operation of a 24-year-old male patient with empyema complicated with secondary thoracic deformity and scoliosis.

Minimally invasive surgery for flat chest: Wung procedure + Wenlin procedure

Flat chest is a special thoracic deformity, which is mainly characterized by flat anterior chest wall. Because the deformity may be combined with mild depression, Nuss procedure was used in the past. However, due to the lack of appropriate fulcrum, this kind of surgery often ends in failure. We designed a special method to treat this deformity. First, we use Wung procedure to change the figure of anterior chest wall into the shape of middle protrusion and bilateral depression, and then we use Wenlin procedure to perform micro-plastic surgery for the chest wall. In this process, we made full use of the advantages of template plastic surgery, so that the advantages of the two procedures were fully reflected, and finally achieved satisfactory results. In this paper, we report the use of this method in a young male patient with flat chest.

Wenlin procedure for treatment of barrel chest

Barrel chest is a kind of thoracic deformity. Clinically, it is always secondary to chronic lung disease, which does not need treatment. Barrel chest is also common in young people and adults. Due to the serious impact on the appearance of the thorax, the patients always have strong desires for surgery. We applied Wenlin procedure to the operation of barrel chest and achieved satisfactory results. This paper introduces the Wenlin procedure of a 25-year-old male patient with barrel chest.

Surgical treatment of severe complex thoracic deformity with Wenlin procedure and Wung procedure

The complex thoracic deformity has both protrusion and depression on the chest wall, and its appearance is complex. It is difficult to complete the correction by ordinary surgical methods. In the early years, this kind of deformity needed to be treated by open surgery. After entering the era of minimally invasive surgery, its operation is also gradually minimally invasive, and it can be completed through the combination of different operations. Mild complex deformities can be treated by sandwich surgery. However, for severe complex deformities, the most ideal combination should be Wenlin procedure combined with Wung procedure. This paper introduces the treatment of a case of severe complex thoracic deformity with this ideal combined operation.

Wang procedure: A reasonable choice for reoperation after failure of Nuss procedure for pectus excavatum

Pectus excavatum is a common thoracic deformity, and Nuss procedure is considered as the standard operation for the treatment of this deformity. However, there are often cases of Nuss procedure failure in the clinic. Once such a situation occurs, it often needs to be operated again. Since Nuss procedure can cause adhesions behind the sternum and in the bilateral thoracic cavities, if Nuss procedure is still used in the reoperation, it is not only very difficult, but also possible to cause heart and lung injuries. Therefore, Nuss procedure is not an ideal choice for reoperation. Wang procedure is a new method to treat the deformity of depressed chest wall. Since this operation is mainly performed outside the chest wall and rarely involves the structures in thoracic cavity, it is suitable for reoperation after the failure of Nuss procedure. This article reports a 12-year-old boy who had a failed Nuss procedure. We used Wang procedure for treatment and achieved satisfactory results.

Reoperation after failure of Nuss procedure on Wenlin chest with Poland syndrome

Wenlin chest is a rare congenital thoracic deformity, which may be combined with other deformities. Because its main lesions are the protrusion and depression of the anterior chest wall, if only one kind of lesions is treated, the deformity will not be corrected completely, and the operation may fail. We met a 20-year-old female patient with Wenlin chest and Poland syndrome who underwent Nuss procedure two years before. The operation was unsuccessful, and the patient still had serious deformity. We performed the reoperation for her, and satisfactory results were obtained.

Application of Wenlin procedure in the treatment of thoracic deformity

Wenlin procedure is a minimally invasive surgery designed for pectus carinatum, which is similar to Abramson procedure to a certain extent, but their natures are completely different. Wenlin procedure is a typical template plastic surgery. This nature makes it possible to be used not only in protrusion deformities such as pectus carinatum, but also in a variety of complex deformities including depression deformities. With the progress of the concept of deformity treatment, the role of Wenlin procedure will become more and more significant.

Thoracic spine deformation may predict prosthetic rehabilitation outcome.

A considerable number of patients require prosthetic ambulation, which necessitates improvements in the success rate of prosthetics. This study aimed to determine the association between the presence of thoracic spinal osteophyte on imaging and the patient's ability to walk with lower leg prosthetics. Retrospective cohort study. This study included 15 patients with lower leg amputations who underwent prosthetic rehabilitation. Medical records and spine radiographs of patients with lower leg amputations between 2013 and 2019 at a private rehabilitation hospital were reviewed. The primary outcome was achieving prosthetic ambulation with a single T-cane or without a walking aid. Poor outcomes were associated with the presence of thoracic spinal deformation (P = 0.007) and the lower Berg Balance Scale score at admission (P = .067) and discharge (P = .033) groups. Monte Carlo simulation results showed a ≥33% difference in walking achieving rate between patients with and without thoracic spinal deformity. In addition, an 18% probability was found for randomly selected persons with an amputation to show a difference of ≥1 point in Berg Balance Scale scores. Thoracic spinal deformity on radiography and Berg Balance Scale score at admission are potentially associated with successful prosthetic rehabilitation. These findings potentially affect the indications for prosthetic limbs.

Long-Term Outcomes of Congenital Diaphragmatic Hernia: Report of a Multicenter Study in Japan.

Background: Treatment modalities for neonates with congenital diaphragmatic hernia (CDH) have greatly improved in recent years, with a concomitant increase in survival. However, long-term outcomes restrict the identification of optimal care pathways for CDH survivors in adolescence and adulthood. Therefore, we evaluated the long-term outcomes within the Japanese CDH Study Group (JCDHSG). Methods: Participants were born with CDH between 2006 and 2018 according to the JCDHSG. Participants were enrolled in the database at 1.5, 3, 6, and 12 years old. Follow-up items included long-term complications, operations for long-term complication, and home medical care. Results: A total of 747 patients were included in this study, with 626 survivors (83.8%) and 121 non-survivors (16.2%). At 1.5, 3, 6, and 12 years old, 45.4%, 36.5%, 34.8%, and 43.6% developed complications, and 20.1%, 14.7%, 11.5%, and 5.1% of participants required home care, respectively. Recurrence, pneumonia, pneumothorax, gastroesophageal reflux disease, and intestinal obstruction decreased with age, and thoracic deformity increased with age. Conclusions: As CDH survival rates improve, there is a need for continued research and fine-tuning of long-term care to optimize appropriate surveillance and long-term follow-up.

Outcome of spine surgery in patients with depressed mental states: a Canadian spine outcome research network study

BACKGROUND CONTEXTDepression is higher among spine patients than among the general population. Some small studies, but not others, have suggested that depression may be a predictor of worse outcome after surgery. PURPOSEDetermination whether there is an association between depression and worse response to surgery among spine patients. STUDY DESIGN/SETTINGThe national, prospective, Canadian Spine Outcome Research Network (CSORN) surgical outcome registry. PATIENT SAMPLEAll patients in the CSORN registry who received surgery for thoracic or lumbar degenerative deformity, stenosis, spondylolisthesis, disc disease, or disc herniation with a minimum of 12 months follow-up postoperation (n = 2310). OUTCOME MEASURESOswestry Disability Index (ODI), SF12 Physical Component Score (PCS), European Quality of Life (EuroQoL), and pain scales. METHODSChange in preoperative to 12-month postoperative ODI, and secondary measures, were compared to assess if there was an association between preoperative depression, as measured by PHQ9, and smaller response to surgery. Multivariate regression analysis was used to search for preoperative factors which might interact with PHQ9 to predict ODI outcome. RESULTSPatients with PHQ9<5, associated with minimal to no depression, had the smallest ODI improvement (−16.8 [95%CI −18.1 to −15.3]) and patients with severe preoperative depression (PHQ9 ≥ 10) had the largest ODI improvement (−22.8 [95%CI −24.1 to −21.5]; p<.00001). Similar findings were found in the EQ5D and PCS. Pain improvement was not different between depression levels. Multivariate modeling found worse baseline PHQ9 and ODI, greater age, nicotine use, more operative levels, and worse American Society of Anesthesiology score was predictive of worse ODI outcomes. CONCLUSIONSDepressed patients have similar or better relative improvements in disability, quality of life, and pain, when compared to nondepressed patients, although their preoperative and postoperative levels of disability are higher. Surgeons should not be concerned that depression will reduce the patient-reported beneficial response to surgical intervention.

Thoracogenic scoliosis: a retrospective review of 129 pediatric patients with a mean follow-up of 10years.

To determine the midterm outcome of lateral thoracotomy (LT) in skeletally immature patients concerning thoracogenic scoliosis development and lung parenchyma resection (LPR) extent. In total, 129 children met the inclusion criteria: (1) LT during the study period; (2) skeletally immature at the time of LT; (3) clinical and radiographic follow-up of at least 3years; and (4) no spinal or thoracic deformity on radiographs before LT. Patients were grouped according to their underlying disease, age at LT, and LPR extent. Radiographic parameters were assessed. Kaplan-Meier survival curves and univariate and multivariate analysis were performed. Of 129, 108 patients underwent pneumonectomy (9; 9.1%), lobectomy (79; 61.2%), segmentectomy (20; 15.5%) and 21 patients LT without LPR. The mean age at LT and at last radiological follow-up was 5.5years (birth-17.8) and 15.2years (3.4-33.2). The mean follow-up was 10years (3-28.1). Scoliosis developed on average 5.3years after LT. The mean Cobb angle was 22.1° (11-90°); > 10° in 37/129 patients (28.7%), of whom 5/129 (3.9%) had > 45°. The average vertebral rotation was 16.2° (2-43°; grade 0-II). RVAD was 26.5° (8°-33°) and 15.3° (2-43°) in patients with Cobb > 45° and ≤ 45°. Gender, age at surgery, and extent of LPR were not risk factors for post-thoracotomy scoliosis (p > 0.05), although younger patients developed a more severe deformity. Although post-thoracotomy scoliosis is not associated with significant rotation, the risk of curve progression > 45° is relatively high. Regular follow-up is required as scoliosis may develop several years after LT with or without LPR.

Pectus excavatum in children

Objective. To study the effect of the degree of pectus excavatum in children on the severity of clinical manifestations, as well as the function of the chest organs before and after surgical treatment.Materials and methods. The study included 36 patients with II-III degree pectus excavatum undergoing surgical treatment and examination at the Orthopedics and Traumatology Department of the Gomel Regional Children’s Clinical Hospital from January 2019 to September 2021. All the patients were examined in clinical setting with laboratory and instrumental methods, were performed electrocardiography, echocardiography, Holter monitoring, the study of the function of external respiration, computed tomography of the chest.Results. As a result of the conducted studies, it has been found that the degree of thoracic deformity in children affects the severity of clinical and functional changes in the chest organs.Conclusion. The performed study has showed that the surgical treatment of pectus excavatum contributes to the elimination of functional disorders in the work of the heart and respiratory organs.

The Versatility of the Fasciocutaneous Infragluteal (FCI) Flaps for locoregional or free flap reconstruction

The wide range of reconstructive purposes requires specific demands and considerations for appropriate flap selection. One versatile and reliable option, which is rarely reported in current literature, is the fasciocutaneous infragluteal (FCI) flap. In this study, we present our results of performing the FCI flap for different clinical indications. This retrospectively study was conducted between September 2011 and September 2019. We included 30 patients (21 females and 9 males) who underwent reconstruction with either pedicled or free FCI flap. Indications for performing FCI flap were uni- or bilateral autologous breast reconstruction, perineal reconstruction, congenital thoracic deformity, lower extremity coverage, and vulva reconstruction. Forty-one FCI flaps were performed (34 free and 7 pedicled flaps). The average flap dimension was 7×20cm (range, 7-8×19-21) and the mean length of the pedicle was 13.4cm (range, 10.5-15.5). The mean diameter of the artery was 2.5mm (range, 2.2-3.2), the mean diameter of the accompanying vein was 3mm (range, 2.4-3.3). The flap survival rate was 97.6% (one flap loss). The most common minor complications were infragluteal wound healing disorders and hematoma. The FCI flap provides constant and reliable anatomy with a long vascular pedicle as well as enough soft tissue bulk and a well-hidden scar. In our clinical practice, this flap has emerged as a first choice in perineal/vulvar reconstruction and a reliable alternative in breast reconstruction if the gold standard procedure cannot be performed. IV (Therapeutic).

Comparison of four correction techniques for posterior spinal fusion in adolescent idiopathic scoliosis.

When performing posterior spinal fusion for adolescent idiopathic scoliosis (AIS), it is of major importance to address both coronal and sagittal deformities. Although several techniques have been described, few data exist comparing them. Our objective was to compare four techniques (in situ bending (ISB), rod derotation (RD), cantilever (C) and posteromedial translation (PMT)) for the correction of spinal deformity in AIS including thoracic deformity. We conducted a multicenter retrospective study including 562 AIS patients with thoracic deformity with at least 24-month follow-up. Radiographic analysis was performed preoperatively, postoperatively and at last follow-up. The main outcomes were main curve correction and thoracic kyphosis restoration (TK). Coronal correction rate was significantly different among the four treatment groups (ISB 64% vs C 57% vs RD 55% vs PMT 67%, p < 0.001). Multivariate regression revealed that correction technique did not influence correction rate, whereas implant density, convex side compression and use of derotation connectors did. TK increase was significantly higher in the PMT group (average + 13°) than in DR (+ 3°), while ISB (-3°) and cantilever (-13°) resulted in TK decrease (p < 0.001). Multivariate analysis revealed that TK increase was only influenced by the reduction technique (p < 0.001) and preoperative TK (p < 0.001). The four techniques had the same ability to correct spinal deformity in the coronal plane. Three factors were identified to improve correction rate: implant density, convex compression and use of derotation connectors. On the other hand, PMT was more effective in restoring TK, particularly in hypokyphotic patients.

Comparative analysis of pulmonary function impairment in adolescent idiopathic vs. congenital scoliosis

Background: Scoliosis is the main three-dimensional pathological backbone deformation with direct effects on the thoracic cage and a prevalence of 0.3 to 15.3% of the population. Aim: To assess the comparison of pulmonary function impairment in adolescent idiopathic and congenital scoliosis. Place and duration of study: Department of Orthopedic &amp; Spine Center, Ghurki Trust Teaching Hospital Lahore from 1st January 2020 to 31st August 2020. Methodology: In this cross-sectional study 30 patients diagnosed with Idiopathic congenital scoliosis after the approval from the Ethical Committee of the hospital (15 idiopathic and 15 congenital scoliosis) were enrolled. The data were collected using predesigned proforma, including demographics (gender, age, BMI, Cobb's angle, and side of deviation) and outcome variables to measure pulmonary function impairment. In all patients, pulmonary function tests were performed. Results: In group A, the mean value of FVC (%) was lower than 80% of the predicted normal value as 59.8±12.0 as compared to group B 78.32±21.35%. The average predicted value of FEV1 was 62.3±13.5%slightly decreased in group A (below 80% of the predicted normal value) compared to group B81.47±19.88%. The FEV1/FVC ratio was normal in both groups (&gt;70% predicted). The result also revealed a significant difference in both groups as (p-value&lt;0.05). Conclusion: Idiopathic and congenital scoliosis is a common thoracic cage weakening deformity with potentially significant and permanent effects of the lungs. As pulmonary symptoms may become clinically apparent unless major and permanent changes have taken place in lung function. It is advisable to recognise the issue early and to conduct routine pulmonary function tests. Keywords: Adolescent Idiopathic scoliosis (AIS), Congenital scoliosis (CS), Cobb angles, forced vital capacity (FVC),

Orthopaedic interventions in occipital horn syndrome: a rare case of mutation in ATP7A gene

BackgroundOccipital horn syndrome is a rare, X-linked recessive, connective tissue disorder caused by abnormal copper transporter proteins coded by the ATP7A gene. 32 cases have been reported worldwide to date. Clinically, patients typically present with inguinal hernia, exostosis, cutis laxa, and bladder diverticula. Orthopaedic problems often include exostosis of the elbows, thoracolumbar scoliosis, thoracic cavity deformities, and joint hypermobility due to joint laxity.Case presentationAn 18-year-old presented with occipital horn syndrome and was treated for flat-valgus foot and posterior dislocation of the elbow joints. Due to collagen structure abnormalities, vulnerability to joint deformation makes treating patients with occipital horn syndrome challenging as they need complex orthopaedic intervention.ConclusionThere is no effective causal therapy for this condition. Surgical procedures can help patients improve their physical condition and maintain adequate joint range of motion.