Repairing chest-wall deformation in children
I Uralboev, Y Akhmedov
State Children Multibranch Medical Center, Samarkand, Uzbekistan
Introduction. Pectus carinatum (PC) is a complex congenital anatomic and cosmetic defect of development in children aged 4 - 18 years. PC can slow physical growth and have psychological effects.
Objective. To determine the efficiency of conservative and surgical repair of PC in children.
Methods. Since 2015, 611 (425 (69.5%) boys and 186 (30.5%)) girls) children with PC have received care and follow-up in our Paediatric Orthopaedic Department. Following Russian authors’ and H J Park of South Korea’s categorisation system, the following PC types were classified: monubriocostal (n=125; 20.5%); corpocostal (n=199; 32.5%); and rib type (n=287; 47.0%). By level, the deformation was divided into: I-level (n=102; 16.7%); II-level (n=281; 46.0%); III-level (n=228; 37.3%). The symmetric type was seen in 331 (54.2%) children, asymmetric in 216 (35.4%); mixed form (Park’s classification) in 46 (7.5%) and upper type in 18 (2.9%). All patients passed complex examination, and 534 (87.3%) were treated conservatively and surgically. Evidence for conservative treatment was cosmetic defect and intrathoracic pressure ≤10 kg, following Yuksel in Turkey, and intrathoracic pressure ≤17 kg and cardiac insufficiency in patients in III-level. A total of 461 (86.3%) patients were selected for conservative treatment, using Yuksel’s orthosis, FMF by M F Marcelo (1992) or orthosis made in Uzbekistan. Evidence for surgery was high intrathoracic pressure (≤10 - ≥25 kg, following Yuksel), high thorax rigidity and a deformation not correctable by conservative means, mostly in children aged 15 - 18 years and older. Operative treatment was used in 73 (13.7%) patients: 44 (63%) with Abramson’s method; 27 (37%) the SandwichII technique; and 2 (2.7%) Ravich’s method.
Results. On follow-up after 6 - 12 months, it was found that: after conservative treatment 408 (88.5%) children had ‘good’ results; 48 (10.4%) had ‘satisfactory’ results; and in 5 (1.1%) it was suggested they continue to wear the orthesis. Following operative repair, 50 (68.5%) had ‘good’ results; 18 (24.7%) were ‘satisfactory’; and fixing of wire movement was needed in 5 (6.8%). In these cases, a second surgery was done successfully. Levelling of the thorax and improvements in the cardiorespiratory system were observed. Moreover, satisfactory cosmetic repair of the defect, and psychological improvements, were noted.
Conclusion. The treatment of PC in children using the suggested methods gave us a high percentage of positive results.
Treatment of thoracic kyphosis in children
I Uralboev, Y Akhmedov
State Children Multibranch Medical Center, Samarkand, Uzbekistan
Introduction. Kyphosis is a complex congenital malformation of spinal curvature resulting in sagittal flatness of back convexity.
Objective. To determine the efficiency of conservative treatment of kyphosis in children.
Methods. A total of 237 children with thoracic kyphosis were under observation and receivedtreatment: 149 (69%) boys and 88 (30.5%) girls, aged 4 - 18 years. Congenital kyphosis was found in 12; derived in 19; postural in 52; rachitic in 8; and mobile or compensatory in 146 patients. According to degree of deformation, they were classified as follows: I degree, 57 (16.7%); II degree, 162 (46.0%); III degree, 18 (37.3%). Thoracic localisation was observed in 209 (54.2%), cervical in 22 (35.4%) and lumbar in 6 (7.5%). In combination with other diseases, it was found with pectus carinatum (PC) in 183, pectus excavatum (PE) in 43 and kyphoscoliosis in 11 patients. Evidence for conservative treatment of patients was intrathoracic compression, intervertebral nerve injuries and cosmetic defect with intercostal damage. With conservative methods, gentle correction of posture was used in 194 (86.3%) patients, and gentle correction and compressive orthosis in cases of combination PC and compressive orthosis. Evidence for operative treatment of kyphosis was III degree kyphosis, an angle >70° from total type and deformation that is uncorrectable by conservative means, especially in children aged 15 - 18 years and older. A total of 13 (13.7%), and 7 patients with kyphoscoliosis, were sent to vertebrology for further treatment.
Results. At follow-up 3, 6 and 12 months after conservative treatment, 147 (88.5%) children had good results, 32 (10.4%) were satisfied, and 15 (1.1%) patients were advised to continue wearing the spine orthosis. Levelling of the spinal column and chest form were observed, and improvement in the function of intrathoracic organs and of intervertebral nerves. Satisfaction with the cosmetic treatment of the thoracic defect and psychological improvements in patients were noted.
Conclusion. The treatment of kyphosis in children according to the suggested methods provided a high percentage of positive results.
Repair of concave-type rib deformation of the chest in children
I Uralboev, Y Akhmedov, N Karimova, S Shamsutdinova
State Children Multibranch Medical Center, Samarkand, Uzbekistan
Introduction. Concave rib deformation (protrusion) of the chest is a frequently observed rib defect in children.
Objective. To examine the development of complex conservative actions with the administration of Eckart Klobe’s vacuum bell (2006, Germany) and operatively setting plates by cross-type (Park, South Korea) on concave ribs deformation.
Methods. In the Paediatric Orthopaedic Department of State Children Multibranch Medical Center, Samarkand, Uzbekistan, 1 504 children with rib deformation and rib-defect development have been examined since 2015, aged from 4 to 18 years. A total of 60 (4%) children aged 4 - 18 were found with concave rib deformation of chest: of these, 41 (68.3%) were observed to have the one-sided type, and 19 (31.7%) two-sided. All patients received complex examination in hospital. Conservative and operative treatment were carried out in 47 (78.3%) patients, and 13 (21.7%) patients had concomitant diseases. Of these, 11 (23.4%) patients were recommended for operation cross-type using Park’s methods (at ages 16 - 18 years), and 36 (76.6%) to use Haecker’s vacuum bell method. Evidence for conservative treatment was cosmetic defect, not very high resistance or flexible rib and impression in lower part of chest.
Results. Evidence for surgery of rib protrusion was high rigidity and resistance of the deformed part, and being unable to correct by conservative means using the vacuum bell, especially in children 16 - 18 years and older. Step-by-step conservative treatment with the help of the vacuum bell in 36 (76.6%) showed that after 3, 6 and 12 months, respectively, 28 (77.9%) patients had good results, 4 (11.1%) were satisfied, 2 (5.5%) were recommended to continue wearing the vacuum bell and 2 (5.5%) patients with unsatisfactory results were recommended the cross-type operation at 16 - 18 years. After the repair, the levelling of ribs and chest form, satisfactory cosmetic repair of the defect and psychological improvement in patients could be observed.
Conclusion. The treatment of rib protrusion in children by the suggested methods yielded positive results.