| Objective:To evaluate the short-term and midterm results objectively and subjectively of the Nuss procedure for the correction of pectus excavatum in children according to age,sex,type and severity of chest depression.Method:120 patients with pectus excavatum underwent a modified sternal turnover operation between January 1985 and April 2005 in this institution.We have performed the Nuss procedure in 115 patients during May 2005 and December 2008. The conditions before,during and after operation and complications were compared during two groups.30 patients who underwent bar removal in Nuss group aged from 3～15 were included in advanced study.Computed tomographic scans were obtained before the Nuss procedure,after the Nuss procedure and after bar removal,and then three CT indices were calculated respectively.Computed tomographic scans of 30 age-matched patients without chest deformity were collected as controls.Patients were divided at 10 years of age into the younger(n = 22) and older(n = 8) groups, groups of boy(n = 24) and girl(n = 6),groups with symmetric type(n = 18) and asymmetric type(n = 12),and groups with mild(n = 18) and severe(n =12) deformity were defined using a pre-CTi value of 5 as border.Follow-up was performed for a mean 34 months after Nuss procedure(range,25～45months).Parents and patients in older group were interviewed at 1～2 years after MIRPE and more than 1 month after bar removal.A single-step-questionnaire(SSQ) and modified single step questionnaire(M-SSQ) that evaluate psychosocial and physical well-being were independently used by patients and parents.The results of CT indices and scores were compared and statistically analyzed.Results:There was no significant difference in age,sex,weight and type between grpups of modified sternal turnover operation and Nuss procedure(P＞0.05).The operative time,time during ICU,duration of hospitalization and amount of blood transfusion were highly significantly less in Nuss group(P＜0.01).Although complication occurred in 25.2%in Nuss group,higher than 15.0%of sternal turnover group,there was no significant difference(P＞0.05).Mean preoperative CTi in all cases was 5.35±3.03 and improved to 2.86±0.42 after Nuss procedure,then to2.82±0.42 after bar removal.Postoperative CTi and After-bar-removal CTi was highly significantly different from preoperative CTi(P＜0.01),but not significantly different from each other(P = 0.472).After-bar-removal CTi was not significantly different from that of the control(2.48±0.242.,P = 0.057).Computed tomographic index of the young group improved from 5.55±3.47 to 2.78±0.42 then to 2.75±0.41,and the older group from 4.81±0.98 to 3.08±0.33 then to 3.03±0.39.These post-CTi and after-bar-removal CTi values were not significantly different respectively in groups of young and older(P = 0.093,P = 0.116),groups of boy and girl(P = 0.469,P = 0.324),and groups of symmetric and asymmetric type(P = 0.281,P = 0.610). Postoperative CTi values between the severe and mild groups were significantly different(P＜0.05),there were not significantly different anymore after bar removal (P = 0.093).There was a high level of persistent satifaction with MIRPE after bar removal,the mean total score was 65.20±5.98(median score = 66.0,maximal score= 76).There was a significant correlation between self and parental assessment (Spearman correlation coefficient = 0.745,P＜0.05 )。Age,sex,type and severity of chest depression had no significant impact on the total scores(P = 0.422,0.183, 0.536,0.522 ).Persistent petus excavatum was noticed in one patient(3.3%)after bar removal,as a result of treatment failure by the dissatisfaction of the patient and her parents.Conclusion:Compared with Sternal turnover operation,Nuss procedure for the correction of pectus excavatum in children has advantages such as little trauma, simple handling.CT scan and questionnaire evaluation could provide objective and subjective evaluation of miterm outcome after the Nuss procedure even after bar removal.Good sternal elevation and persistent satisfaction of both patient and parents can be achieved with the Nuss procedure regardless of age,sex or the type and severity of chest depression.
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