pectus excavatum sternorib lift

The initial surgical correction of the funnel chest was in the early 20th century. With the accumulation of experience, the surgical methods have been continuously improved, and it has been improved day by day, but it is still mainly the sternal inversion method and the funnel chest and chest rib lifting. The funnel chest and chest rib lift was proposed by Broun (1939), which was improved by Ravitch (1944). The main point of surgery is to remove all deformed costal cartilage, free sternum, and make a transverse wedge-shaped osteotomy in the upper part of the sternum, so that the sternum is slightly over-corrected in the forward direction and fixed through the suture. The second or third costal cartilage on both sides is overlapped and fixed (3-point fixation method). Baronofsky (1957) and Welch (1958) have improved this technique, emphasizing the complete preservation of the costal periosteum, periosteum and intercostal muscle bundles. After the orthopedics, most authors at the 5th front rib level, using Kirschner wire to cross the sternum, the Kirschner wire is bow-shaped, keeping the arch back forward, the degree of sternum needs to be raised after the operation, determines the bow of the Kirschner wire Bend. After the Kirschner wire is adjusted, it is fixed on the front ribs of the chest on both sides, and the metal support rod is taken out 1 to 2 years after the operation. In order to avoid re-surgery to take the support rod, bioabsorbable materials are now used as support strips. Recently, Nuss (1998) simply used a sternal posterior support strip, and the costal cartilage was not removed or cut. This funnel chest and chest rib lift is made of stainless steel alloy with a scoliosis and orthodontics. The support strip is made of stainless steel and has a width of 1.25 cm and a thickness of 2.5 mm. The curvature of the support strip is slightly larger than that of the normal thoracic forward. Support the pressure of the thorax. A metal strip is placed behind the sternum to lift the sternum and costal cartilage. The method is less invasive, less complication, and the patient recovers quickly. The follow-up period was up to 10 years and the results were good. But there is still a multi-center research evaluation. Treating disease: funnel chest Indication 1. Non-costal cartilage cutting, resection of thoracic rib lifting is limited to children under 12 years of age. 2. The funnel chest has a heavier respiratory cycle symptoms, prone to fatigue and fatigue, affecting the development of children, is the absolute indication for surgery. 3. Patients with mild respiratory symptoms, severe chest deformation, and greater mental burden should be treated surgically. 4. Beauty is considered to require orthoses. 5. Refer to the funnel chest index, and 0.2 can be operated. 6. The timing of surgery is preferably 3 years old or older, preferably before school. Preoperative preparation 1. Those who need metal support bars should prepare 2 pieces. According to the results of the thoracic measurement of the child, the length of the support strip is selected and roughly formed into a bow shape like a thorax. 2. Patients with respiratory infection before surgery should be controlled and re-operative 1 week after stabilization. 3. Cardiac auscultation should be done by echocardiography to determine whether the heart is compressed by the sternum or combined with congenital heart disease. 4. Severe patients should be examined for pulmonary function as a basis for assessing lung function improvement. 5. Apply antibiotics 2 days before surgery. Surgical procedure Sternal lift (1) Incision: The median longitudinal incision of the sternum, the upper sternal angle is horizontal, down to 2 cm below the xiphoid, or the transverse incision is used at the level of the 4th front rib, and the left and right clavicle midline are reached at both ends of the incision. (2) Subcutaneous and pectoral muscle dissociation: the subcutaneous free range up to the sternal angle, the xiphoid is released, and the ribs and the costal cartilage are connected on both sides. The free range of the thoracic and small muscles is the same as the subcutaneous free. (3) exfoliation of costal cartilage periosteum, excision of partial costal cartilage and sternal wedge osteotomy: along the costal cartilage from the rib and the costal cartilage junction to the sternum, the periosteum is removed around the costal cartilage, but the periosteum is not cut, the inner side close to the sternum will be too long The inferior rib cartilage is resected; at the level of the 2nd and 3rd ribs of the sternum, the sternal periosteum is cut, and the sternal anterior plate wedge is cut off by 0.3 to 0.5 cm. (4) The sternal wedge osteotomy is sutured and sutured to fix the costal cartilage: after the anterior plate of the sternum is cut off by 0.3~0.5cm, the lower end of the sternum is lifted by hand to make the anterior plate of the sternum well, using the 10th silk thread or the coarse polyester. The suture was fixed by suture, and the costal cartilage was removed and sutured, and the periosteum was wrapped and sutured. (5) The sternum support rod raises the sternum: At the level of the 4th and 5th ribs, the thick Kirschner wire is inserted between the anterior and posterior sternum. According to the height of the sternum, the Kirschner wire is different. The bend is curved back. 2. Non-costal cartilage cutting, resected thoracic rib lifting On the sides of the thoracic anterior and midline, the 4th intercostal space was made along the ribs to make a 2.5cm incision. A soft tissue tunnel was separated through the incision. The 30cm long curved Kelly pliers entered the selected intercostal space and slowly moved forward. The sternum is passed through the mediastinum to the corresponding rib between the contralateral side and the skin incision is made. Use the Kelly forceps to open the enlarged passage, and then clamp a traction belt. The other end of the traction belt is connected to the supporting metal strip (1.25cm wide and 2mm thick), exit the Kelly clamp, pull the traction belt, and then support the metal. The strip is placed behind the sternum and the concave surface of the support strip is then rotated backwards. If a support bar is not strong enough, place one more on or under the placed support bar. After the chest rib is lifted, the ends are fixed with the thick wire through the support hole to the periosteum and muscle of the lateral chest wall rib to ensure the stability of the support strip. At the same time, the muscles are sutured and the metal strips are embedded. If two supporting strips are used, the fixing is firm and the displacement is prevented, and the ends of the two supporting strips are fixed by a metal rod, and the metal rod and the supporting strip form a right angle. The incision was sutured layer by layer, and the lung was swollen before suturing the incision, so that the residual gas in the thoracic cavity overflowed and the lungs all expanded After the operation, take a chest X-ray and observe whether there is gas or liquid in the chest. Skin suture should be flat. complication Lung infection, hemorrhage, pneumothorax, and localized infection of the incision. Early symptomatic treatment can be cured. If infection occurs with a metal stent, the stent must be removed and the incision healed and re-surgery. When the stent is not firmly fixed, or when the stent is fixed and the method is not good, it not only affects the orthopedic effect, but also causes the recurrence of the deformity.

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