Yu Jie,Zeng Qi,Chen Chenghao,et al.Preliminary investigation of bar fixation for mini-invasive sternotomy for pectus carinatum based upon measurements of chest wall pressure[J].Journal of Clinical Pediatric Surgery,,22():506-510.[doi:10.3760/cma.j.cn101785-202303001-002]
Preliminary investigation of bar fixation for mini-invasive sternotomy for pectus carinatum based upon measurements of chest wall pressure
- Keywords:
- Pectus Carinatum; Orthopedic Procedures; Minimally Invasive Surgical Procedures; Orthopedic Fixation Devices; Child
- Abstract:
- Objective To explore the outcomes of three different fixation methods during mini-invasive sternotomy for pectus carinatum (PC) based upon sternal manometric measurements of pressure value after depressing anterior chest wall to normal in PC patients.Methods Chest wall pressure values were measured preoperatively in 144 children undergoing mini-invasive sternotomy from July 2012 to July 2016.The selection criteria for bar fixation were formulated according to pressure values and morphological typing of sternotomy.According to specific fixation methods, they were divided into three types of A (bilateral wire), B (bilateral stabilizer) and C (unilateral wire plus unilateral stabilizer).In symmetric type, fixation was performed when pressure value fell under 10 kg;C fixation when it surpassed 10 kg;in asymmetric type, fixation when pressure value dropped below 7.5 kg;B fixation when it was >7.5 kg and yet <10 kg;C fixation when it rose above 10 kg.General profiles, therapeutic outcomes and complications of three groups were summarized.Results All of them completed operations successfully without intraoperative complications, Postoperative complications included pneumothorax (n=4) and wire fracture (n=53).Four cases of minimal pneumothorax were self-absorbed.There were 53 cases of wire fracture (36.81%).The rate of wire fracture at 50% was the highest in A fixation method.Since the appearance of chest wall was not affected, fractured wire was removed at the same time during stent removal.The surgical outcomes were evaluated after bar removal.The excellent rate was 100% without recurrence.Conclusion Formulating preliminary selection criteria for fixation method of mini-invasive sternotomy based upon measurements of chest wall pressure may simplify surgical operations, minimize intraoperative chest wall injury and yield smaller and more aesthetic wounds.Clinical popularization is worthwhile.
References:
[1] Robicsek F, Watts LT.Pectus carinatum[J].Thorac Surg Clin, 2010, 20(4):563-574.DOI:10.1016/j.thorsurg.2010.07.007.
[2] 曾骐, 贺延儒, 李士惠.小儿鸡胸的分型及外科治疗[J].中华胸心血管外科杂志, 1999, 15(4):225-227.DOI:10.3760/cma.j.issn.1001-4497.1999.04.011. Zeng Q, He YR, Li SH.Types and surgical corrections of pectus carinatum in children[J].Chin J Thorac Cardiovasc Surg, 1999, 15(4):225-227.DOI:10.3760/cma.j.issn.1001-4497.1999.04.011.
[3] Abramson H.A minimally invasive technique to repair pectus carinatum.Preliminary report[J].Arch Bronconeumol, 2005, 41(6):349-351.DOI:10.1016/S1579-2129(06)60235-8.
[4] 刘青, 吴晔明.鸡胸的治疗进展[J].临床小儿外科杂志, 2013, 12(1):64-66, 75.DOI:10.3969/j.issn.1671-6353.2013.01.020. Liu Q, Wu YM.Therapeutic advances of chicken breasts[J].J Clin Ped Sur, 2013, 12(1):64-66, 75.DOI:10.3969/j.issn.1671-6353.2013.01.020.
[5] Chen CH, Zeng Q, Li ZZ, et al.Force required for correcting the deformity of pectus carinatum and related multivariate analysis[J].J Pediatr Surg, 2018, 53(9):1855-1857.DOI:10.1016/j.jpedsurg.2017.12.013.
[6] Yuksel M, Lacin T, Ermerak NO, et al.Minimally invasive repair of pectus carinatum[J].Ann Thorac Surg, 2018, 105(3):915-923.DOI:10.1016/j.athoracsur.2017.10.003.
[7] Cohee AS, Lin JR, Frantz FW, et al.Staged management of pectus carinatum[J].J Pediatr Surg, 2013, 48(2):315-320.DOI:10.1016/j.jpedsurg.2012.11.008.
[8] Lee SY, Song IH, Lee SJ.Minimal invasive extrathoracic presternal compression using a metal bar for correction of pectus carinatum[J].Pediatr Surg Int, 2014, 30(1):25-30.DOI:10.1007/s00383-013-3419-0.
[9] 曾骐, 段贤伦, 张娜, 等.大年龄组漏斗胸的微创Nuss手术[J].中华胸心血管外科杂志, 2007, 23(3):193-195.DOI:10.3760/cma.j.issn.1001-4497.2007.03.019. Zeng Q, Duan XL, Zhang N, et al.Nuss procedure for correcting pectus excavatumin in elder group[J].Chin J Thorac Cardiovasc Surg, 2007, 23(3):193-195.DOI:10.3760/cma.j.issn.1001-4497.2007.03.019.
[10] Del Frari B, Sigl S, Schwabegger AH.Complications related to pectus carinatum correction:lessons learned from 15 years’ experience.Management and literature review[J].Plast Reconstr Surg, 2016, 138(2):317e-329e.DOI:10.1097/PRS.0000000000002414.
[11] 陈诚豪, 王君臣, 张娜, 等.鸡胸胸廓有限元模型的建立与验证[J].中华胸心血管外科杂志, 2018, 34(3):129-135.DOI:10.3760/cma.j.issn.1001-4497.2018.03.001. Chen CH, Wang JC, Zhang N, et al.Establishment and verification of pectus carinatum model by finite element methods[J].Chin J Thorac Cardiovasc Surg, 2018, 34(3):129-135.DOI:10.3760/cma.j.issn.1001-4497.2018.03.001.
Memo
收稿日期:2023-03-01。
基金项目:国家呼吸系统疾病临床医学研究中心呼吸专项（HXZX—20210501）；北京市科学技术委员会首都临床诊疗技术研究及转化应用项目（Z211100002921034）
通讯作者:曾骐,Email:zengqi-1@163.com