Thoracic Bone Remodeling and Clinical Therapeutic Effect after Minimally Invasive Repair for Pectus Excavatum in Children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Jifu , XU Bo , WU Shanshan.

Department of Thoracic Surgery, General Hospital of Beijing Military District, Beijing 100700, P. R. China;

Corresponding author：

Keywords：

Pectus excavatum; Minimally invasive surgery; Thoracic bone remodeling

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Abstract： Objective To study thoracic bone remodeling and clinical effects after minimally invasive correction
for pectus excavatum （PE） in children. Methods A retrospective review was conducted of a prospectively gathered
database of 74 child patients who underwent minimally invasive repair of PE at General Hospital of Beijing Military
District between Apr. 2009 and Sept. 2010. Of the patients, 63 were males and 11 females; the age was（ 11.90±8.50）
years, 11 patients ＜ 10-year-old among them. Under general anesthesia, two incisions were made at the side midaxillary
line, and the introducer created a tunnel at the trans-substernum and shaped the thoracic cavity. The bar was then inserted
into the retrosternum by video-assistant thoracoscopic monitoring. All patients were checked by chest computerized
tomography（CT） scan preoperatively and one week after operation, with three-dimensional reconstruction. The sagittal
view was by means of the center line of the body of thoracic vertebrae. The distance between the sternum and the frontal
edge of the body of thoracic vertebrae was measured and the return of displacement of the heart was observed. Results
All 74 operations were successful; there were no deaths. One bar was used for 66 patients （89.19%）, while two bars
were used for the other 8 patients （10.81%）. Comparing the results of pre- with post-correction, for patients younger
than 10 years（n=11） who had one bar placed, the inferior extremity of the manubrium and midsternum displaced
forward to 3.76-22.92 mm. For 11-17 year-old patients（n=55） , anterior displacement of only the middle and lower
part of the midsternum was 2.08-10.42 mm. There was a significant difference between the two groups in the inferior
extremity of the midsternum displaced（t=14.24, P ＜ 0.05）. For those patients with two bars, the inferior extremity of
the manubrium and the midsternum were each displaced forward 4.19-15.03 mm at 7 d after operation. At 7 d after operation,
the cardiac position in 65 patients（ 87.84%） of the all putted back by CT image. The chest shape of patients who received two
bars was better than that of patients who received one bar. After 6-23 months of follow-up, it was pre-operative symptoms
disappeared in the patients, chest shape was satiation. Cardiac position in all patients was completely recovered. Conclusion
The thoracic bones of children with PE after minimally invasive repair have favorable remodeling. Older children require
greater strength of support of the sternum during correction, but still realize a satisfactory therapeutic effect.

Citation： LIU Jifu,XU Bo,WU Shanshan.. Thoracic Bone Remodeling and Clinical Therapeutic Effect after Minimally Invasive Repair for Pectus Excavatum in Children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 39-42. doi: Copy

1.	minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33（4）：545-552.
2.	?2 Nagasao T, Miyamoto J, Tamaki T, et al. Stress distribution on the thorax after the Nuss procedure for pectus excavatum results in.
3.	different patterns between adult and child patients. J Thorac.
4.	Cardiovasc Surg， 2007, 134（6）：1502-1507.
5.	?3 Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252（6）：1072-1081.
6.	?4 曾骐, 彭芸, 贺延儒, 等. Nuss手术治疗小儿漏斗胸（附60例报告）. 中华胸心血管外科杂志， 2004， 20（4 ）：223-225.
7.	?5 刘吉福, 薛文平, 徐波,等.微创矫治成人漏斗胸近期临床疗效分析. 中国微创外科杂志, 2009, 9（5 ）：418-420.
8.	?6 鲁亚南, 刘锦纷, 徐志伟, 等. 改良Nuss手术纠治小儿漏斗胸. 中国胸心血管外科临床杂志, 2007, 14（2）：93-96.
9.	?7 Nakagawa Y, Uemura S, Nakaoka T, et al. Evaluation of the Nuss procedure using pre-and postoperation computed tomographic index. J Pediatr Surg, 2008, 43（3）：518-521.
10.	?8 Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac.
11.	compression with the Nuss minimally invasive repair for pectus.
12.	excavatum. J Pediatr Surg, 2006, 41 （4）： 683-686.
13.	?9 Nagasao T, Noguchi M, Miyamoto J, et al. Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum. J Thorac Cardiovasc Surg, 2010, 140（6）：1294-1299.
14.	forces on the thoracic cage of patients with pectus excavatum after the Nuss procedure. Clin Biomech （Bristol,Avon）, 2008, 23（7）：881-885.
15.	procedure in children with pectus excavatum： independent survey of the first 20 years’ data. J Cardiothorac Surg, 2008, 3（1）：40.
16.	picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg, 2008, 17（3）：181-193.
17.	correction of pectus excavatum in adults patients. J Thorac.
18.	Cardiovasc Surg, 2006, 132（3）：524-529.
19.	decrease postoperative pain after the Nuss procedure. J Thorac.
20.	Cardiovasc Surg, 2010, 140（1）：39-44.
21.	Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a.
22.	Chang PY, Hsu ZY, Chen DP, et al. Preliminary analysis of the.
23.	Protopapas AD, Athanasiou T. Peri-operative data on the Nuss.
24.	Kelly RE Jr. Pectus excavatum： historical background, clinical.
25.	Mavanur A, Hight DW. Pectus excavatum and carinatum： new concepts in the correction of congenital chest wall deformities in the pediatric age group. Conn Med, 2008, 72（1）：5-11.
26.	Pilegaard HK, Licht PB. Routine use of minimally invasive surgery for pectus excavatum in adults. Ann Thorac Surg, 2008, 86（3）：952-956.
27.	Schalamon J, Pokall S, Windhaber J, et al. Minimally invasive.
28.	Olbrecht VA, Abdullah F, Arnold MA, et al. Upper sternal depression following Lorenz bar repair of pectus excavatum. Pediatr Surg Int, 2008, 24（7）：843-846.
29.	Nagaso T, Miyamoto J, Kokaji K, et al. Double-bar application.

1. minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33（4）：545-552.
2. ?2 Nagasao T, Miyamoto J, Tamaki T, et al. Stress distribution on the thorax after the Nuss procedure for pectus excavatum results in.
3. different patterns between adult and child patients. J Thorac.
4. Cardiovasc Surg， 2007, 134（6）：1502-1507.
5. ?3 Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252（6）：1072-1081.
6. ?4 曾骐, 彭芸, 贺延儒, 等. Nuss手术治疗小儿漏斗胸（附60例报告）. 中华胸心血管外科杂志， 2004， 20（4 ）：223-225.
7. ?5 刘吉福, 薛文平, 徐波,等.微创矫治成人漏斗胸近期临床疗效分析. 中国微创外科杂志, 2009, 9（5 ）：418-420.
8. ?6 鲁亚南, 刘锦纷, 徐志伟, 等. 改良Nuss手术纠治小儿漏斗胸. 中国胸心血管外科临床杂志, 2007, 14（2）：93-96.
9. ?7 Nakagawa Y, Uemura S, Nakaoka T, et al. Evaluation of the Nuss procedure using pre-and postoperation computed tomographic index. J Pediatr Surg, 2008, 43（3）：518-521.
10. ?8 Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac.
11. compression with the Nuss minimally invasive repair for pectus.
12. excavatum. J Pediatr Surg, 2006, 41 （4）： 683-686.
13. ?9 Nagasao T, Noguchi M, Miyamoto J, et al. Dynamic effects of the Nuss procedure on the spine in asymmetric pectus excavatum. J Thorac Cardiovasc Surg, 2010, 140（6）：1294-1299.
14. forces on the thoracic cage of patients with pectus excavatum after the Nuss procedure. Clin Biomech （Bristol,Avon）, 2008, 23（7）：881-885.
15. procedure in children with pectus excavatum： independent survey of the first 20 years’ data. J Cardiothorac Surg, 2008, 3（1）：40.
16. picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg, 2008, 17（3）：181-193.
17. correction of pectus excavatum in adults patients. J Thorac.
18. Cardiovasc Surg, 2006, 132（3）：524-529.
19. decrease postoperative pain after the Nuss procedure. J Thorac.
20. Cardiovasc Surg, 2010, 140（1）：39-44.
21. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a.
22. Chang PY, Hsu ZY, Chen DP, et al. Preliminary analysis of the.
23. Protopapas AD, Athanasiou T. Peri-operative data on the Nuss.
24. Kelly RE Jr. Pectus excavatum： historical background, clinical.
25. Mavanur A, Hight DW. Pectus excavatum and carinatum： new concepts in the correction of congenital chest wall deformities in the pediatric age group. Conn Med, 2008, 72（1）：5-11.
26. Pilegaard HK, Licht PB. Routine use of minimally invasive surgery for pectus excavatum in adults. Ann Thorac Surg, 2008, 86（3）：952-956.
27. Schalamon J, Pokall S, Windhaber J, et al. Minimally invasive.
28. Olbrecht VA, Abdullah F, Arnold MA, et al. Upper sternal depression following Lorenz bar repair of pectus excavatum. Pediatr Surg Int, 2008, 24（7）：843-846.
29. Nagaso T, Miyamoto J, Kokaji K, et al. Double-bar application.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Thoracic Bone Remodeling and Clinical Therapeutic Effect after Minimally Invasive Repair for Pectus Excavatum in Children

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