| Objective:To evaluate the midterm results objectively and subjectively of the Nuss procedure for the correction of pectus excavatum in children according to age, gender, type and severity of chest depression.Method:From May 2005 to December 2009, the Children's hospital affiliated to Fudan University provided Nuss treatment to 135 young children.42 patients (ages from 3-15 years) who had steel bar removed with a mean 31.2 months (range,25-43) follow-up composed Experimental Group A for the Haller index study. Based on the factors of age, gender, type, and deformity, the patients were respectively divided into the younger group (age<10 years, n=25) and elder group (age>10, n=17), the boy group (n=35) and the girl group (n=7), the symmetric-typed group (n=24) and the asymmetric-typed group (n=18), and the mildly deformed group (Haller index<5, n=18) and the severely deformed group (Haller index>5,n=25).Computed tomography index was collected before the Nuss procedure, before and after the bar removal.The controlled group A included 42 young children with a good match in age, gender, height and weight, but without cardiopulmonary diseases, chest deformity and psychological disease. Out of 42,27 patients (ages from 6-15 years), who were no less than 6 years old when receiving the Nuss procedure and had undergone their steel bar removed, were included in advanced study of pulmonary function. These young patients were put into the symmetric-typed group (n=15) and the asymmetric-typed group (n=12), and the mildly deformed group (Haller index<5, n= 16) and the severely deformed group (Haller indeX>5,n=11).They received routine pulmonary function examination before the Nuss procedure, before and after the bar removal.27 young children,with a good match in age, gender, height and weight, but without cardiopulmonary diseases, chest deformity and psychological disease, received pulmonary function examination, included as controlled group B. Contrastive analysis of the Haller index and routine pulmonary function data on the three said time points were individually conducted between experimental group and controlled group, and also between the subgroups. All the patients'parents and young patients aging over 10 years received the first questionnaire 2-3 years after the Nuss procedure and the second after the bar removal. The instruments included a single-step-questionnaire (SSQ) and modified single step questionnaire (M-SSQ).The data analysis focused on the correlation between patients' and their parents'responses, and the influence of the four factors on the subjective assessment.Results:The average Haller index in the 42 Nuss cases reduced from the preoperative 5.32±2.82 to 2.87±0.54 before bar removal, then to 2.86±0.54 after bar removal. The statistical Haller index tested before and after Nuss operation attested a significantly difference (P<0.01),yet an insignificant difference was found between the pre-bar-removal Haller index and post-bar-removal Haller index (P=0.605). Post-bar-removal Haller index was not significantly different from that of the controlled group (2.55±0.23,P=0.057).Both in the younger group and the elder group, no significant differences were noted between pre-bar-removal and post-bar-removal (respectively, P=0.333,P=0.115).Statistics demonstrated insignificant differences before and after bar removal in the boy group (P=0.169),in the girl group(P=0.234),in the symmetric group (P=0.243),in the asymmetric group (P=0.279),in the mildly deformed group (P=0.542),and in the severely deformed group (P=0.176).The pulmonary function data after the bar removal were not significantly different from that before the bar removal both in the symmetric group and the asymmetric group.The preoperative indexes of VC, RV, FVC,and FEV1 in the severely deformed group were significantly lower than those in the standard group (P<0.01),but the preoperative indexes of TLC and FEV1/FVC manifested no significant difference (P>0.05);pre-bar-removal indexes of VC,FVC, FEV1 was greatly improved (P<0.05), but the indexes of RV, RV/TLC, FVC and FEV1 at this stage were still significantly lower than the standard children (P<0.05);no significant statistical difference appeared in the pre-bar-removal stage and the post-bar-removal stage.The total score of M-SSQ questionnaire was averaged 65.68 (medium 66.0, range:41-76).The Spearman correlation efficient between the elder patients' responses and the parents'responses was distinctively high with 0.748 (P<0.05).In the two surveys conducted in different stages, the parents'satisfaction to the overall health, exercise tolerance, physical appearance, overall results,thoracic appearance had statistical significance and high correlation with their re-assessment (P<0.01). The Kruskal-Wallis test showed had no statistically significant difference of the total score in the younger group versus the elder group (P=0.143),in the boy group versus the girl group (P=0.132), in the symmetry group versus the asymmetry group (P=0.242), and in the mildly deformed group versus the severely deformed group (P=0.252).Of all the interviewees, two (4.8%) felt dissatisfied with the operation results, which showed the failure of the treatment.Conclusion:CT scan, routine pulmonary function examination and questionnaire evaluation could provide objective and subjective evaluation of midterm outcome after the Nuss procedure even after bar removal. Good sternal elevation, fine pulmonary function improvement and persistent satisfaction of both patient and parents can be achieved with the Nuss procedure regardless of age, sex or the type and severity of chest depression. |
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