| Background and Objective:Pectus excavatum is the most common anterior chest wall deformity in children.Studies have shown that the Nuss procedure is now the preferred operation for surgical correction because of its low trauma,rapid recovery,and good orthopedic results.The Haller index is described as the ratio of the thoracic width to the thoracic height within the thoracic cage used in the assessment of pectus excavatum.However,there are few studies on the improvement of the whole thorax by surgical treatment and whether it reaches the normal level.The aim of this study is to evaluate the impact of Nuss procedure and bar removal by comparing changes in the dimensions of the thoracic cavity of pectus excavatum patients with CT image and then compare data with the normal children to get an idea of the growth of the thoracic cage.Methods and materials:(1).A total of 50 patients with pectus excavatum were treated in the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2018 were retrospectively analyzed.The dimensions were measured at every vertebral level from the 3rd to 12th thoracic plane using the Haller index methodology to compare the effects of NUSS procedure and bar removal on the thoracic cage.(2).We grouped the patients by age and the length of bar duration.The differences of anterior chest wall changes between different groups were analyzed to explore the related factors.(3).We collected totally 700 children with normal thoracic cage aged 5 to 18 years old from January to October in 2019.The transverse and anteroposterior diameters at multiple vertebral levels of the thorax were measured in each patient to analyze the growth of the thorax after surgery.SPSS22.0 statistical software was used for statistical analysis and P<0.05 was considered statistically significant.Results:1.The post-bar removal data showed that the anteroposterior diameters from the 8th to 12th vertebral levels were significantly higher than their before NUSS procedure,whereas the 3rd to 5th anteroposterior diameters and 8th to 10th transverse diameters were lower than the preoperative values(P<0.05).The ratio of transverse diameter to anteroposterior diameter increased in the 3rd to 5th thoracic vertebrae planes and decreased in the 7th to 12th thoracic vertebrae levels.2.After bar removal repair,the transverse diameters increased in the 7th,8th,9th and 12th thoracic vertebra levels compared with the data before bar removal and the difference was statistically significant(P<0.05).The anteroposterior diameters decreased and the ratio of transverse diameter to anteroposterior diameter increased in each level(P<0.05).3.Compared with pre-operation of NUSS procedure,patients aged below 10 years old and the duration of bar in situ longer than 2 years groups whose anteroposterior diameters changes after bar removal were larger than the other groups in multiple vertebral levels(P<0.05),difference was statistically significant.Changes of transverse diameter were significant different at the 10th to 12th thoracic vertebrae levels in two age groups and at 5th thoracic vertebrae in different duration time of bar in situ.4.The transverse diameters at the 8th to 11th vertebral levels and anteroposterior diameters at all vertebral levels of post-bar removal group showed statistically significant compare to the group of normal children(P<0.05)Conclusion:1.Correction of anterior depression of the sternum were obviously observed in PE patients following the Nuss procedure,but anteroposterior diameters are still less than the level of normal children.Correction before puberty and longer correction time can provide better results.2.The transverse diameter of the thoracic cavity is limited to some extent. |
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