Study On The Effect Of Orthopedic Sequence On The Pectus Excavatum With Scoliosis

At present,the order of correction of pectus excavatum combined with scoliosis is not uniform.The purpose of this study is to study the effect of different orthopedic orders on surgical outcome of pectus excavatum combined with scoliosis.To investigate the effect of predictive correction of pectus excavatum on scoliosis,and to study the effect of prediction of scoliosis correction on pectus excavatum,which can reduce the risk of surgery and improve the quality of surgery.The thorax model of the same case was established by three modeling methods,including 3D entity reconstruction model,3D entity simplification model and beam element model.Considering the modeling efficiency and calculation accuracy,3D entity simplified model is chosen as parametric research object.Based on the clinical imaging data,four simplified models of pectus excavatum combined with scoliosis were established by using UG 3D modeling software,including pectus excavatum in the concave side of scoliosis and scoliosis in the upper side of the pectus excavatum(ipsilateral upper),pectus excavatum in the concave side of scoliosis and scoliosis in the lower side of the pectus excavatum(ipsilateral lower),pectus excavatum in the convex side of scoliosis and scoliosis in the upper side of the pectus excavatum(contralateral upper),pectus excavatum in the convex side of scoliosis and scoliosis in the lower side of the pectus excavatum(contralateral lower),four different thoracic model.Four different thorax models were imported into ANSYS finite element software,the effect of predictive correction of pectus excavatum on scoliosis was studied by numerical calculation.We also studied scoliosis correction and pectus excavatum correction,and then released scoliosis correction to predict the impact on pectus excavatum.The results of numerical simulation showed that the scoliosis symptoms of ipsilateral upper model were improved when pectus excavatum correct in advance,and the scoliosis symptoms in the other three models were aggravated.The symptoms of pectus excavatum in four kinds of thoracic models were aggravated when the spine was stretched in advance.The ipsilateral upper chest model and the contralateral upper thoracic model pectus excavatum collapsed most seriously.The force displacement curves of the four models were compared.The results showed that the correction force of the ipsilateral upper thoracic model and the ipsilateral lower thoracic model was greater than that of the contralateral lower thoracic model and the contralateral upper thoracic model.Simultaneous spinal stretching and pectus excavatum correction,and release of scoliosis correction,the stress of the ipsilateral upper and the contralateral upper thoracic models is smaller than that of the simple pectus excavatum correction.Analysis of the spine results showed that simultaneous correction was not conducive to scoliosis,and not only decreased the degree of improvement and more lateral bending,but also had greater equivalent stress on the spine compared with the simple pectus excavatum correction.Different orthopedic sequences have different therapeutic effects on pectus excavatum combined with scoliosis.From the numerical simulation results,the first pectus excavatum correction may be more beneficial,but different types of scoliosis have different effects on the operation.Generally,when the pectus excavatum is located on the convex side of the scoliosis,it is unfavorable to the spine.The first correction of scoliosis is unfavorable to pectus excavatum,regardless of typing,which can aggravate pectus excavatum symptoms.Simultaneous spinal stretching and pectus excavatum correction,and release of scoliosis correction,it is detrimental to scoliosis,but beneficial to the reduction of thoracic stress.