In order to identify whether the regeneration of costal cartilage is the basis of post-surgical repair of pectus excavatum and thoracic cage remodeling, 151 cases were followed up for 0.25 to 14 years. The main procedures in treatment were 3 steps: To curve the mental strut as a bow, to repair the perichondrium as a tube, and to persist in post-operative therapy. The results showed that regeneration of the costal cartilages appeared 3 months postoperatively in the cases treated by this method. It was concluded that a satisfactory thoracic cage could be remodeled by improving the technique of repairing pectus excavatum and persisting in postoperative therapy according to the regeneration regularity.
Congenital chest deformity is caused by abnormal development of spine or ribs, resulting in sternal depression or protrusion. Pectus carinatum and pectus excavatum are the most common diseases in clinic, which can either be accompanied by other syndromes or exist alone. The genetic factors of congenital thoracic deformity can be related to single gene mutation, polygene mutation and chromosome aberration. Common clinical congenital thoracic deformity with syndromes, such as Marfan syndrome and Noonan syndrome, often have relatively fixed and clear pathogenic genes. The genetic pathogenesis of non-syndromic and independent congenital thoracic malformations is usually diverse, and treatments for syndromic and non-syndromic congenital thoracic deformity are different. Therefore, it is necessary for us to differentiate syndromic and non-syndromic congenital thoracic deformities in basic research, clinical diagnosis and treatment.
Objective To explore the clinical application effect and technical advantages of percutaneous suspension technique via sternal elevation device-assisted pectus excavatum (PE) correction. Methods Patients who underwent percutaneous suspension technique via sternal elevation device-assisted PE correction at West China Hospital of Sichuan University from July to August 2025 were consecutively enrolled, and their clinical data were analyzed. Results A total of 5 PE patients were included in the study, including 4 males and 1 female, aged 14 to 27 years, and the preoperative Haller index ranged from 3.44 to 7.65. Among them, 4 patients underwent PE correction assisted by percutaneous suspension technique via balance-shaped sternal elevation device, and one underwent PE correction assisted by percutaneous suspension technique via single sternal elevation device. All operations were completed successfully, with a significant expansion of the retrosternal space, smooth implantation of the steel plate, and no complications. The operation time ranged from 29 to 48 minutes, and the intraoperative blood loss was 2 to 5 mL. The patients recovered well after surgery, and the satisfaction rate with thoracic wall appearance correction was 100%. Conclusion The percutaneous suspension technique via sternal elevation device-assisted PE correction can safely expand the retrosternal operating space. This crucial expansion reduces surgical risks and optimizes the orthopedic outcome, underscoring its significant clinical value for minimally invasive treatment of PE.
ectus exeavatum is the most common chest wall deformity. The impairment of cardiopulmonaryfunction, severe psychological injury and other complications will be caused by the deformity. ″TheSternal Turnover″and″ The Sternal Elevation″are respective difference in indications andcharacteristics to treatment of pectus exeavatum. Pectus excavatum deformity will be repaired with theproper procedure and postoperative treatment. Their exercise tolerance and cardiac function will alsobe impro...
Objective To summarize the effectiveness of Nuss procedure by thoracoscopy for correction of pectus excavatum. Methods Between September 2009 and January 2012, 33 patients suffering from pectus excavatum underwent Nuss procedure by thoracoscopy. There were 26 males and 7 females, aged from 3 to 22 years (median, 9 years). There was primary operation in 32 cases and reoperation in 1 case after Ravitch procedure. Twenty-four patients had obvious clinical symptoms. The Haller index ranged from 3.3 to 50.1 (mean, 5.6). According to simplified Park classification, 25 cases were classified as symmetric type, 5 as eccentric type, and 3 as unbalanced type. Results Intercostal muscle tear occurred in 1 case during operation; pleural effusion, pulmonary infection, and thoracic vertebral pain occurred in 1 case, respectively after operation. The operation time ranged from 38 to 89 minutes (mean, 60.9 minutes). The intraoperative blood loss was 8-90 mL (mean, 26.2 mL). The postoperative hospitalization days were 6-12 days (mean, 7.6 days). All patients were followed up 12-39 months (mean, 25.6 months). Electrocardiogram and chest X-ray film showed that cardiac compression was improved, and symptoms alleviated. At the last follow-up, according to the Nuss standard, the results were excellent in 27 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 90.9%. There was no significant difference in results of effectiveness evaluation among less than 6 years, 6-12 years, and more than 12 years groups (Z= — 1.751, P=0.109). Conclusion Nuss procedure by thoracoscopy has the advantages of little trauma, simple operation, and fast recovery, so it can obtain satisfactory correction of pectus excavatum.
ObjectiveTo summarize the clinical experience and investigate the safety and reliability of uniportal procedure for the correction of pectus excavatum (PE). MethodsFrom November 2010 to November 2015, 203 PE patients (164 males, 39 femalzs average age of 5.7±3.0 years, ranging from 2 to 19 years) underwent the correction operation with only single 2 cm incision on right lateral chest. There were 188 patients under 12 years of age and 15 patients above 12 years. According to Park classification, 176 patients were symmetric and 27 were asymmetric. ResultsAll operations were performed successfully. The average operating time was 16.1±5.2 min with a range of 4-65 min and the average postoperative hospital stay was 6.4±1.3 d, ranging from 4-14 d. A single incision was made on the right chest and only one bar was inserted in the patients. Postoperative follow-up was 1-56 months (mean, 27.6 months). There was no complication occurred such as bar turnover, displacement and redepressed sternum. Totally, 84 patients received bar removal procedure. ConclusionIn terms of operation time and surgical trauma, uniportal procedure for PE is superior to Nuss procedure. And there is no significant difference in the safety and effectiveness between two procedures. Uniportal procedure is especially suitable for the treatment of PE children under 12 years of age.
Pectus excavatum (PE) is a common congenital chest malformation in children, manifested by inward depression of the anteriorthorax wall, which can compress the normal tissues and organs in the chest and cause adverse effects on the physiology and psychology of patients. Surgery is the most important means of treating PE, and with the invention of Nuss surgery, the surgical treatment of PE has entered the minimally invasive era. At present, there are many indexes to evaluate the severity of thoracic malformations in PE patients, and selecting appropriate evaluation indexes is of great significance for the formulation of surgical protocols. As a physical and mental disease, PE's deformed thoracic appearance not only affects the function of thoracic organs, but also affects the psychological state of patients. Therefore, there is still controversy over whether the role of orthopedic surgery is to improve function or cosmetic plastic surgery. At the same time, the orthopedic efficacy and postoperative complications of the existing modified and novel surgical methods need to be further observed and evaluated. In addition, the design of surgical plan and the selection of surgical timing for PE combined with other diseases are also critical and controversial issues in clinical practice. Therefore, this article explores and reviews the controversial points in the current surgical treatment of PE.
ObjectiveTo investigate the effect of anterior chest wall depression on the cardiac function and the effectiveness of minimally invasive surgery for pectus excavatum by comparing cardiac function and morphology between pre- and post-operation. MethodsBetween August 2009 and December 2010, 102 adult patients with pectus excavatum were treated with minimally invasive surgery, including the primary operation in 95 cases and the reoperation in 7 cases. There were 84 males and 18 females, aged 18-57 years (mean, 23.4 years). The haller index (HI) was 4.59 ± 1.51. Of 102 patients, 59 were classified as pectus excavatum type I and 43 as type II; 42 had clinical symptoms and 19 had the physical sign of heart. The preoperative chest CT examination showed cardiac compression in all patients and heart displacement in 74 patients. The left ventricular ejection fraction (LVEF) was 68.9% ± 6.2%. ResultsThe procedure was successful in all patients, and no death or serious complication occurred. The patients were followed up 12-28 months (mean, 21 months). The clinical symptoms and cardiac physical sign of the patients disappeared after operation. HI was 2.70 ± 0.33 at 12 months after operation, showing significant difference when compared with preoperative HI (t=5.83, P=0.00). According to Nuss’s evaluation method, the results were excellent in 99 patients and good in 3 patients. CT examination showed complete relief of cardiac compression in 101 patients and mild cardiac compression in 1 patient; the heart position was normal at 12 months after operation. Electrocardiogram returned to normal in 4 patients having abnormal electrocardiogram. LVEF was 70.5% ± 4.8% after operation, showing no significant difference when compared with preoperative LVEF (t=1.08, P=0.30). ConclusionThe main effects of pectus excavatum in adults on heart are compression and displacement. Cardiac compression may be relieved efficiently and the patient’s clinical symptoms can be abated by minimally invasive surgery.
Objective To assess the efficacy and summarize the treatment experience in correction of recurrent pectus excavatum by the non-thoracoscopic minimally invasive Nuss procedure. Methods From July 2003 to November 2007, 21 patients with recurrent pectus excavatum were treated with surgical repairs. Among them, there were 15 patients who underwent a Nuss procedure (the recurrent Nuss group), 13 males and 2 females, aged (13.31 ± 4.21) years old, and the preoperative CT scan showed the mean Haller index was 3.98 ± 0.94. The recurrence time of the depression after the primary operation was different: 2 patients with less than 1 year, 4 with 1-3 years, 7 with 3-5 years and 2 with over 5 years. There were 6 patients who underwent a modified Ravitch procedure (the recurrent Ravitch group), 5 males and 1 female, aged (13.67 ± 2.23) years old, and the mean Haller index was 3.92 ± 1.01. The recurrence time of the depression after the primary operation was as follows: 2 patients with less than 1 year, 1 with 1-3 years and 3 with 3-5 years. Another 119 patients had a primary Nuss procedure in the same period (the primary Nuss group), 95 males and 24 females, aged (7.79 ± 3.59) years old, and the mean Haller index was 4.61 ± 1.36. In terms of the age and the Haller index, there was significant difference between the recurrent Nuss group as well as the recurrent Ravitch group and the primary Nuss group (Plt; 0.05), but there was no significant difference between the recurrent Nuss group and the recurrent Ravitch group (Pgt; 0.05). Results All the patients were performed with the surgery successfully without any severe compl ications. The operation time, blood loss and postoperative hospital ization time of the recurrent Nuss group and the primary Nuss group were significantly less than those of the recurrent Ravitch group (P lt; 0.05), but there was no significant difference between the recurrent Nuss group and the primary Nuss group (P gt; 0.05). All the patients were followed up for 1.5-37.0 months (11.2 months on average). Except for 1 with plate displacement and 2 with suture reaction in the primary Nuss group who were readmitted to hospital, the other patients recovered well. The patients had perfect thoracic appearances with increased exercise tolerance and had a significantly improved psychological condition and an active social participation because of their improved appearances. The postoperative mean Haller index was 2.58 ± 0.31, 2.77 ± 0.48 and 2.52 ± 0.34 in the recurrent Nuss group, the recurrent Ravitch group and the primary Nuss group, respectively, with significant difference compared with the preoperative mean Haller index in each group (Plt; 0.05). Conclusion Although the recurrent pectus excavatum repairs are technically more challenging than the primary surgery, the non-thoracoscopic Nuss procedure for reoperative correction is a safe, effective and rel iable method.
ObjectiveTo summarize the experience of treating adult recurrent pectus excavatum without plate turnover.MethodsTwenty-seven patients with recurrent pectus excavatum treated by thoracoscopy-assisted placement without plate turnover from 2010 to 2019 in our hospital were enrolled. There were 23 males and 4 females with the age of 3-29 (12.81±7.79) years at the first operation, and 18-29 (21.74±3.56) years at this operation. Incision of 2-3 cm at bilateral axillary midline of the deepest point of pectus excavatum was made, and an auxiliary incision under xiphoid process was adopted according to the intraoperative situation.ResultsAll patients underwent thoracoscopy-assisted correction of pectus excavatum without bar turnover, and subxiphoid incision was performed in 11 patients. Twenty-five patients had one bar placed, and two patients required two bars. The operation time was 28-45 (33.00±6.44) min. Postoperative Haller index (2.95±0.40) was improved compared with preoperation (4.63±1.03). The postoperative hospital stay was 4-6 (4.00±0.32) day. All patients were followed up for 1-8 years. Complications included poor wound healing in 1 patient, and steel wire fracture and displacement in 1 patient. There was no plate rotation or bar displacement. Fourteen patients removed the bar 29-84 (40.36±13.93) months after the placement. Haller index was improved to 2.43-3.61 (2.86±0.35) during removal of steel plate. Untill June 2020, there was no recurrence of pectus excavatum.ConclusionThe treatment of adult recurrent pectus excavatum without plate turnover is satisfactory, and the protection of intercostal muscle and firm fixation is the key to ensure the success of operation and long-term effects.