Presence of manubrium-sternum joint does not assure sufficient elevation of sternum in Nuss procedure for pectus excavatum patients.

Nuss Pectus excavatum Recurrence Sternum Thorax

Journal

General thoracic and cardiovascular surgery
ISSN: 1863-6713
Titre abrégé: Gen Thorac Cardiovasc Surg
Pays: Japan
ID NLM: 101303952

Informations de publication

Date de publication:
17 Jan 2024
Historique:
received: 29 08 2023
accepted: 06 12 2023
medline: 17 1 2024
pubmed: 17 1 2024
entrez: 17 1 2024
Statut: aheadofprint

Résumé

The manubrium and body of the sternum are connected by the manubrium-sternum joint (MSJ). In performing the Nuss procedure for pectus excavatum patients, the body of the sternum is elevated as the operator flips correction bars upside down. Theoretically, the presence of the MSJ should allow elevation of the sternum body. However, does the MSJ secure sufficient elevation of the sternum? This study aims to elucidate this clinical question. Seventy-four adult pectus excavatum patients with moderate to serious deformity (with Haller Index being equal to or greater than 5) were included in the study. The MSJ was open in all patients. For 29 patients, the sternum was elevated by only bar flipping (Non-Separation Group); for 45 patients, the sternum was horizontally separated after bar flipping (Separation Group). Whether or not additional elevation for Separation Group patients results from the division was observed, and the degree of the additional elevation was evaluated. Furthermore, 74 patients subjectively evaluated postoperative pain and gave scores with a Visual Analog Scale ranging from 0 (no pain) to 10 (intolerable pain). The VAS scores were compared between the two groups. In the Separation Group, the sternums of all patients achieved additional elevation from sternum separation. The pain scores were lower for the Separation Group than for the Non-Separation Group. Even when the MSJ is present, horizontal separation enhances the elevation of the sternum. Furthermore, horizontal separation of the sternum reduces postoperative pain.

Sections du résumé

BACKGROUND BACKGROUND
The manubrium and body of the sternum are connected by the manubrium-sternum joint (MSJ). In performing the Nuss procedure for pectus excavatum patients, the body of the sternum is elevated as the operator flips correction bars upside down. Theoretically, the presence of the MSJ should allow elevation of the sternum body. However, does the MSJ secure sufficient elevation of the sternum? This study aims to elucidate this clinical question.
METHODS METHODS
Seventy-four adult pectus excavatum patients with moderate to serious deformity (with Haller Index being equal to or greater than 5) were included in the study. The MSJ was open in all patients. For 29 patients, the sternum was elevated by only bar flipping (Non-Separation Group); for 45 patients, the sternum was horizontally separated after bar flipping (Separation Group). Whether or not additional elevation for Separation Group patients results from the division was observed, and the degree of the additional elevation was evaluated. Furthermore, 74 patients subjectively evaluated postoperative pain and gave scores with a Visual Analog Scale ranging from 0 (no pain) to 10 (intolerable pain). The VAS scores were compared between the two groups.
RESULTS RESULTS
In the Separation Group, the sternums of all patients achieved additional elevation from sternum separation. The pain scores were lower for the Separation Group than for the Non-Separation Group.
CONCLUSION CONCLUSIONS
Even when the MSJ is present, horizontal separation enhances the elevation of the sternum. Furthermore, horizontal separation of the sternum reduces postoperative pain.

Identifiants

DOI: 10.1007/s11748-023-02001-x PMID: 38231367
pubmed: 38231367
doi: 10.1007/s11748-023-02001-x
pii: 10.1007/s11748-023-02001-x
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : JSPS KAKENHI Grant-in-Aid for Scientific Research (C)
ID : 22K12783

Informations de copyright

© 2024. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.

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Auteurs

LinXuan Wu (L)

Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan.

Tomohisa Nagasao (T)

Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan. nagasao.tomohisa@kagawa-u.ac.jp.

Atsushi Hosokawa (A)

Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan.

Tomoki Miyanagai (T)

Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan.

Classifications MeSH