Thoracic bone remodeling after minimally invasive repair for pectus excavatum in adults and its clinical efficacy / 解放军医学杂志

ABSTRACT

Objective To study thoracic bone remodeling after minimally invasive corrective surgery for pectus excavatum (PE) in adults and ascertain its clinical efficacy. Methods A total of 82 patients aged 18 to 57 (23.5 6.1) were enrolled in this study. There were 67 male patients and 15 female patients. The symmetric type (? type) composed of 37 cases, whereas the nonsymmetric type (II type) comprised 45 cases. Haller index (HI) was 3.2 to 11.8. Under general anesthesia, incisions located on looth sides of the mid-axillary line were made in all patients. The prepared supporting bar was inserted behind the sternum by videoassisted thoracoscopic monitoring (one bar for 60 patients and two bars for 22 patients). All patients were checked by chest CT scan pre-operation and 1 week post-operation to create a three-dimensional reconstruction thoracic image. In the sagittal plane, the center line of the body of the thoracic vertebrae was regarded as the incision line. The distance was measured between the sternum and the frontal edge of the body of the thoracic vertebrae. The condition of the displacement of the heart was also observed. Results When one bar was used, the middle and the inferior extremity of the mid-sternum was moved forward for 8.69 and 15.69mm, respectively, after correction. There was significant difference compared with that of the pre-operation (P<0.01). However, the upper extremity of the mid-sternum and upper and inferior extremities of the manubrium were moved forward to 2.39, -2.38, and 1.44mm, which did not exhibit obvious difference compared with the values taken before the operation. When two bars were used for the patients, the inferior extremity of the manubrium and each of upper, middle, and inferior extremities of the mid-sternum showed a forward displacement for 10.8, 12.45, 17.61, and 20.62mm, respectively. There was significant difference compared with the pre-operative values (P<0.001). The upper extremity of the manubrium exhibited forward displacement of 2.34mm, which did not exhibit any significant difference with the pre-operative values. The CT image showed the cardiac position returned to normal after operation. The thoracic appearances when two bars were used were better compared with that using one bar. Conclusions The strength of the reshaping bar is useful in thoracic bone remodeling after minimally invasive repair for PE in adult. Thoracic bone remodeling using one bar or two bars showed different change regularities and mechanisms of mechanics.