Three-dimensional Changes Of Thorax After Nuss Procedure For Pectus Excavatum
Jin Yong Jeong, Eun Young Rha.
Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of.
OBJECTIVE: The Nuss procedure corrects the chest wall deformity by inserting the metal bar in pectus excavatum. Considering the three-dimensional structure of thoracic cavity, we evaluated the thoracic dimensional changes after Nuss procedure.
METHODS: We performed a retrospective review of 141 patients who had undergone the Nuss procedures. The thoracic dimensions were measured using anteroposterior and lateral diameters at three anatomical landmarks (jugular notch, manubriosternal joint and xiphisternal joint) in computed tomographic scan. Preoperative and postoperative Haller index and thoracic dimensions were compared among each group according to the age, type and inserted bars. The paired t-test was used to compare the differences within each group.
RESULTS: Of the 141 patients (115 men, 26 women), 87 patients were symmetric and 54 patients were asymmetric type. The postoperative anteroposterior diameters in manubriosternal and xhiphisternal joint were significantly higher than the preoperative values. The Haller index, lateral diameters in jugular notch, manubriosternal joint and xiphisternal joint were significantly lower than the preoperative values. In age>13, asymmetric type and multiple bar inserted group, the postoperative anteroposterior diameters in manubriosternal joint and xiphisternal joint were significantly higher than the preoperative values. However, postoperative lateral diameters in three anatomical landmarks were significantly lower than the preoperative values (Table 1).
CONCLUSIONS: The increased anteroposterior and decreased lateral diameter in three anatomical landmarks were noted in pectus excavatum patients after Nuss procedure. These results would be related to the postoperative changes of thoracic cavity volume. Further research would be warranted to determine the relationship between this phenomenon and pump handle action and postoperative changes of total lung volume.
|Jugular notch||Manubriosternal joint||Xiphisternal joint|
|AP diameter||LAT diameter||AP diameter||LAT diameter||AP diameter||LAT diameter|
AP = anteroposterior; LAT = lateral; Sym = symmetry; Asym = Asymmetry; S = single; M = multiple
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