Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2024, Vol. 20 ›› Issue (02): 224 -230. doi: 10.3877/cma.j.issn.1673-5250.2024.02.014

Original Article

Causes analysis, prevention and management of bar displacement after Nuss procedure

Yaoyue Li1, Junmei Ma1, Qin Jiang1, Pengyuan Chen1, Fang Hou1, Bing Xu1, Wenying Liu1,()   

  1. 1. Department of Paediatric Surgery, Sichuan Provincial People′s Hospital, University of Electronic Science & Technology of China, Chengdu 610072, Sichuan Province, China
  • Received:2023-12-26 Revised:2024-02-21 Published:2024-04-01
  • Corresponding author: Wenying Liu
  • Supported by:
    Sichuan Province Tianfu Ten-Thousand Talent Program, Tianfu Renowned Doctor Program(A.0101760); Key Research Project of Department of Science & Technology of Sichuan Province(2021YFS0381); Specialized Fund of Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital(2021ZX03)
Objective

To explore the causes of bar displacement after minimally invasive orthopaedic Nuss procedure for pectus excavatum, and to summarise the preventive and treatment measures.

Methods

A total of 17 patients admitted to Sichuan Provincial People′s Hospital from June 2010 to February 2022 with bar displacement after Nuss procedure were selected into this study. Their clinical case data were retrospectively analysed to summarize the causes of bar displacement and its treatment measures. This study was approved by the Medical Ethics Committee of Sichuan Provincial People′s Hospital (Approval No. 2023-46). Informed consents were obtained from all patients or their guardians.

Results

① The patients in this study were 15 males and 2 females, aged (12.8±4.7) years old (5.5-25.3 years old), with Haller index of 3.6±0.3 (3.3-4.3). ② Of the 17 patients in this study: 14 cases had the bar flipping, 1 case had the bar flipping combined with lateral sliding, and 2 cases had the dorsal shift of the bar (ages 25.3 and 18.3 years old, respectively); there were 13 cases of asymmetric pectus excavatum and 4 cases of symmetric type; and there were 12 patients whose age was >12 years old. ③ All 17 patients were reoperated to adjust the bar, and the bars were consolidate with stabilizer and medical stainless steel wire. Among them, 2 cases were found to have bar flipping >3 months after Nuss procedure, and the fixed plate was placed by replacing the rib gap after selecting a new incision to take out the plate; the remaining 15 cases were found to have bar displacement within 0-3 months after Nuss procedure, and the bar was relocated by replacing the rib gap through the original incision (4 cases) or reset the bar through the original incision with the original rib gap (11 cases) and re-fixed. ④ Of the 17 patients in the study, 6 cases had inappropriate bar placement, 8 cases had confirmed or suspected history of strenuous activity or trauma after the Nuss procedure, 13 cases had asymmetrical pectus excavatum, 2 cases had severe sternal recess, and 12 cases were >12 years old.

Conclusions

Appropriate age at the time of Nuss procedure in pectus excavatum patients, appropriate bar type and placement, and avoidance of premature strenuous activity or trauma after surgery are the main measures to reduce bar displacement after Nuss procedure. Once the postoperative bar displacement is found, it should be corrected and handled in a timely manner depending on the specific situation.

图1 1例钢板上下倾斜移位患儿(男性,18.5岁)胸部X射线摄片图(可见钢板安置位置在第5~6肋间隙,位置过高,未在胸壁最凹陷处)  图2 1例钢板上下倾斜移位患儿(男性,8.3岁)胸部X射线摄片图  图3 1例钢板上下倾斜移位合并左右横向移位患儿(男性,14.0岁)胸部X射线摄片图
表1 本组17例Nuss手术后不同类型钢板移位患者胸廓对称性、性别、年龄比较[例数(%)]
表2 本组17例Nuss手术后不同类型钢板移位患者安置钢板位置、钢板固定方式及手术切口选择比较
表3 本组17例Nuss手术后不同类型钢板移位患者钢板移位原因比较(例)
[1]
Haecker FM. Evolution in the management of pectus excavatum in pediatric patients[J]. Transl Pediatr, 2023, 12(8): 1450-1453. DOI: 10.21037/tp-23-264.
[2]
Aly MR, Farina JM, Botros MM, et al. Minimally invasive repair of pectus excavatum in adults: a review article of presentation, workup, and surgical treatment[J]. J Thorac Dis, 2023, 15(9): 5150-5173. DOI: 10.21037/jtd-23-87.
[3]
Croitoru DP, Kelly RE Jr, Goretsky MJ, et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients[J]. J Pediatr Surg, 2002, 37(3): 437-445. DOI: 10.1053/jpsu.2002.30851.
[4]
Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum[J]. J Pediatr Surg, 1998, 33(4): 545-552. DOI: 10.1016/s0022-3468(98)90314-1.
[5]
王学军,徐冰,刘文英,等. Nuss微创漏斗胸矫形术后并发症及其处理[J]. 中国修复重建外科杂志2009, 23(11): 1343-1346.
[6]
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 1 215 patients[J]. Ann Surg, 2010, 252(6): 1072-1081. DOI: 10.1097/SLA.0b013e3181effdce.
[7]
刘文英. 关于漏斗胸手术治疗的若干问题[J]. 临床小儿外科杂志2016, 15(2): 110-113. DOI: 10.3969/j.issn.1671-6353.2016.02.003.
[8]
刘文英,魏艇,唐耘熳,等. 微创新术式矫治47例漏斗胸的经验[J]. 中华小儿外科杂志2005, 26(8): 407-409. DOI: 10.3760/cma.j.issn.0253-3006.2005.08.005.
[9]
Castellani C, Schalamon J, Saxena AK, et al. Early complications of the Nuss procedure for pectus excavatum: a prospective study[J]. Pediatr Surg Int, 2008, 24(6): 659-666. DOI: 10.1007/s00383-008-2106-z.
[10]
Goretsky MJ, McGuire MM. Complications associated with the minimally invasive repair of pectus excavatum[J]. Semin Pediatr Surg, 2018, 27(3): 151-155. DOI: 10.1053/j.sempedsurg.2018.05.001.
[11]
Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience[J]. J Thorac Dis, 2015, 7(Suppl 2): S172-S176. DOI: 10.3978/j.issn.2072-1439.2015.04.07.
[12]
Sacco Casamassima MG, Goldstein SD, Salazar JH, et al. Perioperative strategies and technical modifications to the Nuss repair for pectus excavatum in pediatric patients: a large volume, single institution experience[J]. J Pediatr Surg, 2014, 49(4): 575-582. DOI: 10.1016/j.jpedsurg.2013.11.058.
[13]
Park HJ, Chung WJ, Lee IS, et al. Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum[J]. J Pediatr Surg, 2008, 43(1): 74-78. DOI: 10.1016/j.jpedsurg.2007.09.022.
[14]
刘吉福,薛文平,刘克强,等. 成人漏斗胸胸腔镜辅助矫治32例[J]. 中华胸心血管外科杂志2010, 26(2): 129-130. DOI: 10.3760/cma.j.issn.1001-4497.2010.02.021.
[15]
陶麒麟,贾兵,闫宪刚,等. 单切口改良Nuss手术矫治儿童漏斗胸[J]. 中国微创外科杂志2016, 16(2): 127-130. DOI: 10.3969/j.issn.1009-6604.2016.02.008.
[16]
吴娜,谢乂民,陈思远,等. 微创Nuss手术治疗儿童漏斗胸的研究进展[J]. 临床小儿外科杂志2020, 19(2): 176-180. DOI: 10.3969/j.issn.1671-6353.2020.02.017.
[17]
徐冰,曹李明,刘文英,等. Nuss手术矫治漏斗胸412例[J]. 中华胸心血管外科杂志2011, 27(11): 645-647. DOI: 10.3760/cma.j.issn.1001-4497.2011.11.003.
[18]
Velazco CS, Arsanjani R, Jaroszewski DE. Nuss procedure in the adult population for correction of pectus excavatum[J]. Semin Pediatr Surg, 2018, 27(3): 161-169. DOI: 10.1053/j.sempedsurg.2018.05.002.
[19]
吉毅,刘文英,徐冰,等. 非胸腔镜辅助微创Nuss手术矫治复发漏斗胸[J]. 中国修复重建外科杂志2008, 22(10): 1213-1217. DOI: 10.3321/j.issn:0529-5815.2008.08.003.
[20]
徐冰,刘文英,吉毅,等. 非胸腔镜辅助Nuss手术矫治大年龄患儿漏斗胸[J]. 中华小儿外科杂志2008, 29(7): 408-410. DOI: 10.3760/cma.j.issn.0253-3006.2008.07.008.
[21]
Fonkalsrud EW, Reemtsen B. Force required to elevate the sternum of pectus excavatum patients[J]. J Am Coll Surg, 2002, 195(4): 575-577. DOI: 10.1016/s1072-7515(02)01245-0.
[22]
卞军,徐泉. 漏斗胸Nuss术后并发肋间肌撕裂危险因素分析[J]. 中华胸心血管外科杂志2021, 37(10): 606-609. DOI: 10.3760/cma.j.cn112434-20201222-00550.
[23]
麦苏德·马合木提,丹尼尔·多里坤,张海平,等. 胸腔镜辅助微创手术(改良型Nuss术)矫正治疗小儿漏斗胸的临床疗效[J/OL]. 中华妇幼临床医学杂志(电子版), 2022, 18(2): 228-233. DOI:10.3877/cma.j.issn.1673-5250.2022.02.015.
[24]
de Loos ER, Pennings AJ, van Roozendaal LM, et al. Nuss procedure for pectus excavatum: a comparison of complications between young and adult patients[J]. Ann Thorac Surg, 2021, 112(3): 905-911. DOI: 10.1016/j.athoracsur.2020.10.017.
[25]
Ganescu O, Emil S, Saint-Martin C, et al. Postoperative pain following minimally invasive repair of pectus excavatum: a descriptive study[J]. J Pediatr Surg, 2022, 57(5): 918-926. DOI: 10.1016/j.jpedsurg.2021.12.051.
[26]
陈佳俊,徐慧姣,蒋琴,等. 外科治疗先天性膈肌发育异常疾病患儿的随访研究 [J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(1): 1-8. DOI: 10.3877/cma.j.issn.1673-5250.2024.01.001.
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