Objective To compare the rib regeneration in patients with adolescent idiopathic scoliosis (AIS) after convex short length rib resection or conventional thoracoplasty. Methods Between January 2005 and December 2009, 36 patients with Lenke 1 AIS underwent posterior correction, instrumentation, and fusion, and the clinical data were retrospectively analyzed. Conventional thoracoplasty was performed in group A (n=14), convex short length rib resection in group B (n=22). There was no significant difference in gender, age, Cobb angle of major curve, flexibility, and preoperative rib hump between 2 groups (P gt; 0.05). The standing long-cassette anteroposterior and lateral X-ray films of spine were taken at 3 months, 6 months, l year, and 2 years respectively after operation. Rib regeneration classification established by Philips was used to analyze the rib formation. Results All patients were followed up 32 months on average (range, 24-48 months). Cobb angle of major curve and rib hump were significantly improved when compared with preoperative values in 2 groups (P lt; 0.05), and there was no obvious correction loss. At each time point after operation, there was no significant difference in Cobb angle of major curve between 2 groups (P gt; 0.05), but the rib humb of group B was significantly bigger than that of group A (P lt; 0.05). The rib regeneration in group B was better than that in group A, showing significant difference (P lt; 0.05). At 3 months after operation, 80.0% rib regeneration was below grade 4 in group A, and 96.3% rib regeneration reached grade 4 or above in group B. At 2 years after operation, 52.0% and 96.3% rib regeneration reached grade 6 or above in groups A and B, respectively. Conclusion The rib regeneration in patients with AIS after convex short length rib resection is better than that after conventional thoracoplasty.
ObjectiveTo review the current development in therapy of congenital funnel chest. MethodsRecent literature concerning the development of the treatment method for congenital funnel chest was extensively reviewed and summarized. ResultsThe main therapies for congenital funnel chest are thoracoplasty (Ravitch sternum elevation procedure and minimal invasive Nuss procedure) and prosthesis implantation. The magnetic mini-mover procedure and the vacuum bell are still in the research phase. ConclusionBesides the improvement in function, the requirement in appearance after surgery is also improved in the treatment of congenital funnel chest. The minimally invasive surgery and non-invasive procedures could be expected in the future.
Objective To evaluate pulmonary function changes in patients with severe scol iosis undergoing anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. Methods FromJanuary 2006 to July 2007, 16 patients with severe scol iosis were treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. There were 6 males and 10 females with an average age of 16.9 years (range, 10-24 years). There were 1 case of Lenke 1 curve, 9 cases of Lenke 2 curve, and 6 cases of Lenke 4 curve. The preoperative Cobb angle was (104.8 ± 10.9)° and the preoperative thoracic kyphotic angle was (30.0 ± 4.2)°. The preoperative height of “razor back” deformity was (5.9 ± 1.2) cm. Before operation, the actual value of forced vital capacity (FVC) was (2.04 ± 0.63) L and that of forced expiratory volume in 1 second (FEV1.0) was (1.72 ± 0.62) L. The percentage of actual values to expected ones in FVC was 70% ± 16%, and that in FEV1.0 was 67% ± 15%. All patients had pulmonary function tests before operation and 3, 6, 12, 24 months after operation. Results All wounds healed by first intention. The Cobb angle at 24-month follow-up was (53.4 ± 18.6)° and the correction rate was 49.0% ± 15.3%. The thoracic kyphotic angle at 24-month follow-up was (34.0 ± 2.4)° and the correction rate was 13.3% ± 2.2%. The height of “razor back” deformity at 24-month follow-up was (2.2 ± 0.8) cm. Compared with preoperative level, all these data showed significant differences (P lt; 0.05). At 3 and 6 months, the actual values of FVC and FEV1.0 decl ined, but no significant difference was found (P gt; 0.05). At 12 and 24 months, the actual values of FVC andFEV1.0 were close to the preoperative level (P gt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 indicate continued improvement in pulmonary function from the postoperative 3 to 24 months follow-up. Compared with preoperative level, the percentages of actual values in FVC decl ined 19% 3 months postoperatively (P lt; 0.05) and 12% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FEV1.0 decl ined 16% 3 months postoperatively (P lt; 0.05), and 10% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 were close to the preoperative level 12 and 24 months after operation (P gt; 0.05). Conclusion In severe scol iosis patients who are treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib, pulmonary function decreases obviously 3-6 months after operation. And it returns to the operative baseline 12-24 months after operation.