Conservative and Surgical Treatment of Children with Pectus Carinatum (PC)
Ikromjon Uralboev, Yusufjon Akhmedov*
Samarkand State Children Multibranch Medical Center, Uzbekistan
TOPICALITY
PC is a complex congenital defect of development. Apparent anatomic and cosmetic defect and changes in psychiatry of children, especially in children at older ages (5-18).
RESEARCH OBJECTION
Determine the efficiency of conservative and surgical repair.
MATTER AND METHODS
In Children Orthopedic Department 312 children with PC have been under care and observation since 2015. From them 194 (62,1%) boys and118 (37,9%) girls, at the ages from 4-18. We used G. Bairova and A. Fokina’s classifications, (Russia, 1983), by type the followings were detected: monubriocostal in 74 (23,7%) children; corpocostal - 172 (55,1%) (from them pyramidal- 129; round chest-43); rib-type 66 (21,1%) patients. By level they were divided into: I-level 95 (33%), II-level 92 (30%), III-level 125 (37%) children. Symmetric type is in 198 (66,9%) patients, asymmetric in 82 (24%) and mixed form (by Park H.J.) in 32 (9.1%). All patients have passed complex examination in hospital. 178 (57%) patients were treated by conservative and surgical methods.
Evidence to conservative method of treatment has been cosmetic defect and intrathoracic pressure (p≤10 by M.Yuksel classification, Turkey). During conservative treatment the compressing orthosis (made by M. Yuksel) were used in 145 (81,4%) patients.
Evidence to the surgery was high intrathoracic pressure (p≤10-25 and more p≥25 kg by M.Yuksel), high thorax rigidity and uncorrectable deformation by conservative way. Mostly with children at 15 and older. 31 (17,4%) patients were used minimally-invasive method by Abramson, 2 (1.1%) by Ravich.
RESULTS
In 6-12 months: after conservative method 119 (82%) children are considered “good”; 23 (15,8%) “satisfactory”; 3 (2%) patients to continue wearing orthesis again. Leveling of thorax form could be observed. Satisfactory of chest cosmetic repair and improvement of psychology have been detected.
CONCLUSION
Treatment of PC by suggested method allowed to get high percentage of positive results.
Conservative and Surgical Treatment of Children with Pectus Excavatum (PE)
Ikromjon Uralboev, Yusufjon Akhmedov*
Samarkand State Children Multibranch Medical Center, Uzbekistan
TOPICALITY
PE is an anatomic disease linked with cardio-pulmonological symptoms, cosmetic defect and also psychological perception.
Objection
Determine the Conservative and Surgical Repair efficiency.
RESEARCH METHODS
In Children Orthopedic Department, by examination 619 children from 2 to 18 have been found in Samarkand since 2015, from them 344 (55,5%) boys and 275 (45,5%) girls. All patients have passed complex examination in hospital. The patients have been treated by conservative and surgical methods.
By N.Kondrashina’s (1968) classification of PE the following was detected: simple form in 564 (91,1%), plano-PE in 55 (8,9%). By shape: 163 (26,3%) symmetric, 456 (73,7%) asymmetric; By level: 198 (31,9%) patients with I-level (depth up to 2sm without ectopiacordis); II-level 266 (43,1%) (depth 2-4sm, ectopia-cordis to 2-3 sm), III-level 155 (25%) (depth more than 4sm, ectopia-cordis more 3 sm). 23 (3,7%) patients were observed combination with other congenital pathology: congenital dislocation of hip-joint 15 (2,4%), scoliosis 5 (0,8%), Morph’s syndrome 3 (0,4%).
By stage of growth-compensatory in 487 (78,6%), subcompensatory in 127 (20,5%) and decompensation in 5 (0,8%) patients.
The Vacuum Bell was used in 38 (6,1%) patients with symmetric and asymmetric form of I-II-level. In apparent deformation of II, III-level method by NASS was used in 95 (15,3%) patients and by Ravich in 2 (0,3%).
Good results have been observed after conservative treatment with Vacuum Bell in 24 (63,1%) patients and by NASS’s method in 77 (81%) in 6-12 months. Deformation in patients wasn’t observed, the capacity of breath became normal. Satisfied results were found in 6 (6,3%), unsatisfied in 7 (7,3%) - from them 2 (2,1%) had plate rotation problem, 3 (3,1%) hypercorrection and 2 (2,1%) fixed wire movement. Second surgery was carried out with positive results.
Therefore, PE requires careful observation, preparation and selection of patients to both conservative and operative methods of correction.