The Research On The Pre-and Post Operative Chest Flat Degree Of Nuss Procedure And The Clinical Effect In The Different Age Patients With Pectus Excavatum

Objective:To investigate the relationship of the chest flat degree along with the age, and the clinical efficiency before and after the surgery, then provide the information about the ideal age for surgery, according to the retrospective research on the pre and post-operative chest flat degree of Nuss procedure in the different age patients with pectus excavatum.Method:(1) Measuring the chest flat degree:20patients of3-6years old,6-12years old, older than12years in each group, were selected and treated with Nuss procedure. Chest X-ray examinations of AP view and lateral view were taken on all the patients before surgery and1years later, the chest flat index was anteroposterior diameter of the thorax (diaphragmatic level) divided by the transverse diameter of the thorax (the distance from the posterior border of2nd body sternum top to spine). The same amount of normal children compared with the patients who has the similar age, sex, height, weight were selected as control group before and after the surgery, and the other batch of non-surgery children compared with the patients who has the similar age, sex, height, weight were selected as control group after the surgery. The control group were measured as the same way.(2) The clinical orthopedic effects:compared the perioperative situation(such as operation time, amount of blood loss, length of stay, time of ambulation, time of analgesics taking), postoperative complications, postoperative orthopedic effects of all patients.Result:(1) The chest flat index in the different age control group was not significantly different(P>0.05); the chest flat index between the preoperative and control group was significantly different (P<0.05), the preoperative chest index between groups of different ages was significantly different (P<0.05), the older the patients were, the bigger the chest flat index was. The post-operative groups of3-6and6-12years old were separately compared with the normal control groups. The index is elevated with no significant difference (P>0.05), compared with the normal control group, the chest flat index in older than12years old group did not fully return to normal levels, but there was significant difference between the postoperative patients and non-surgery patients (P <0.05).(2) All the patients were successfully operated; there was no significant difference about operation time, amount of blood loss, postoperative hospital stay among groups of different ages. But the older the patients were, the longer time of analgesic taking and ambulation was, which was of significantly difference. The incidence of postoperative complications had no significant difference among groups of different ages, with eusemia. The orthopedic effects were fine except one case older than12years old group, which varied inversely with age. Hence, there was significant difference between older12years old group and the younger groups (P<0.05).Conclusion:(1) The patients with pectus excavatum have flatter thoraxes than the normal children, furthermore, the chest flat degree exacerbates with age.(2)1year after surgery, the chest flat index improves much, which in the3-6years old and6-12years old group can reach the normal level, which in the older than12years old group improves significantly without reaching the normal level.(3) The percentage of asymmetric pectus excavatum and mental disorders significantly increases with age.(4) Nuss procedure can achieve fine orthopedic effects, which varies inversely with age.(5) According to our studies, we consider that the ideal age for Nuss procedure is the period of3-6years old.