RU2373878C1 - Method of treating inborn pigeon brest in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. Transverse sternotomy is performed at base of sternum bend. At the level of most projected sternocostal hump, on lateral surfaces of chest, contra-aperture accesses are made, through which in opposite direction to each other hypodermic tunnel is formed. In tunnel metal plate, made in form of springy arc, is placed. After that simultaneous compression of sternum and immobilisation of sternocostal complex with fixation of plate ends to ribs are performed.

EFFECT: claimed method is minimally traumatic, ensures stable fixation of sternocostal complex and good cosmetic effect.

1 ex, 6 dwg

Description

The invention relates to medicine, namely to surgery, and can be used for surgical treatment of congenital keeled chest deformity in children of all ages.

Various methods of surgical treatment of congenital keeled chest deformity are known. So, there is a method of treating keeled chest deformity, including mobilization of the chest by segmental bilateral resection of the II-VII ribs in the parasternal region, 0.5 cm from the sternum. Chondrotomy of the ribs is carried out 1.0-1.5 cm medial to the border of the bone-cartilaginous part, as well as in the place of the most deformed sections of the ribs. A wedge-shaped sternum resection and sternotomy are performed. The sternal-rib complex in tension is fixed with perforated titanium plates laid on the front surface of the skeleton of the sternum and ribs (Shamik V.B. Osipochev S.N. MKI ⁷ A61V 17/00).

The disadvantages of this method include its high invasiveness, due to wide transverse access along the front surface of the chest, wide mobilization of the skin and soft tissues, which leads to impaired microcirculation and ischemia.

Significant disadvantages of this method include the postoperative decrease in the total volume of the chest and its excursion. In addition, this surgery is accompanied by blood loss from 50 to 150 ml. A wide transverse scar in the cosmetic plan has a negative point.

Closest to the technical nature of the proposed is a method of surgical treatment of keeled chest deformity, including performing transverse sternotomy. The known method is as follows. A linear skin incision is made from the jugular notch of the sternum handle to the xiphoid process. Skin with subcutaneous fat is exfoliated on both sides to the external boundaries of the deformity. The xiphoid process is cut off from the sternum and taken down with a muscle flap. Dull way mobilize the back surface of the sternum, pleural leaves exfoliate on both sides. A bilateral segmental resection of the deformed sections of the costal cartilage (from II to YII-YIII ribs) is performed. Depending on the type of deformation (manubrio-bone type, corporeal-bone type: round or pyramidal shape, corporeal-bone type asymmetric deformation), various types of sternotomy are performed - transverse, double transverse or in combination with longitudinal with fixation of sternum fragments by Kishner knitting needles. To achieve the optimal chest shape in children with CDHC, compression pads of the required shape and size are used. After activating the patient and removing the sutures through an external device, a modeling compression-distraction effect on the chest is carried out. After 2-2.5 months, the device is removed and under general anesthesia, the Kishner spokes are removed. The protective regimen is prescribed for 1 month. In the future, the child leads a normal lifestyle (Zhila N.G. Surgical modeling correction of congenital and acquired chest deformities in children. Diss. ... MD - Khabarovsk, 1999, p.165-180).

The significant disadvantages of this method include the fact that the correction of deformation is carried out (on average) for one year. Prolonged pressure on soft tissues often leads to ischemia and necrosis. In this case, the patient experiences a feeling of limited movement and discomfort.

The objective of the proposed technical solution is to develop a method of surgical treatment of congenital keeled chest deformity in children of all age groups.

The technical result of the proposed method is to increase the effectiveness of treatment due to intraoperative elimination of deformation of the sterno-costal complex and ensuring stable fixation in a corrected position, as well as achieving a cosmetic effect.

The technical result is achieved by the fact that a method of treating congenital keeled chest deformity in children involves performing transverse sternotomy.

The difference of the proposed method lies in the fact that a transverse sternotomy is performed at the base of the curvature of the sternum, then at the level of the greatest protrusion of the sternum-rib hump.

Distinctive techniques of the proposed method is also the fact that on the lateral surfaces of the chest cause contrapertural accesses, through which a subcutaneous tunnel is formed towards each other.

The difference from the known solutions is that through the subcutaneous tunnel a metal plate is made and placed in it, made in the form of a spring arc.

The main difference of the proposed method is that after placing the plate in the subcutaneous tunnel, simultaneous compression of the sternum and immobilization of the sternum-rib complex with fixation of the ends of the plate to the ribs are performed.

A comparative analysis of the proposed method and the prototype shows that the claimed method differs from the known above methods. These differences allow us to conclude that the claimed technical solution meets the criteria of the invention of "novelty."

From the analysis of patent and specialized literature, the authors found that the proposed technical solution has features that distinguish it not only from the prototype, but also from other technical solutions in this field of medicine. No method was found for the treatment of congenital keeled chest deformity in children, containing the distinctive techniques of the proposed technical solution.

The inventive method allows to achieve the technical result perceived by the applicant and the authors, namely, to increase the effectiveness of treatment by intraoperatively eliminating deformation of the sterno-costal complex and ensuring stable fixation in a corrected position, as well as by achieving a cosmetic effect.

Distinctive techniques of the proposed method in combination with a metal plate made in the form of a spring arc, allow simultaneous elimination of keeled deformation with simultaneous compression of the sternum.

In contrast to the prototype, the proposed method allows for intraoperative removal of keeled chest deformity, which ensures the psycho-emotional comfort of the patient in the postoperative period.

The proposed method is minimally traumatic, provides stable fixation of the sterno-costal complex and a good cosmetic effect.

The advantage of the proposed method from previously proposed is to reduce the risk of developing introoperative and postoperative complications, reducing the traumatic effect on the tissue of the sterno-costal complex.

The above allows us to conclude that the proposed method meets the criterion of "inventive step".

The method comprising the claimed invention is intended for use in healthcare. This method can be used in surgery. The possibility of its implementation is confirmed by the methods and means described in the application, therefore, the proposed solution meets the criteria of the invention "industrial applicability".

The essence of the proposed method is illustrated by 6 figures, reflecting the stages of its implementation, where: 1 - contourtural accesses on the lateral surfaces of the chest wall, 2 - transverse access to the projection of the sternum body, 3 - transverse sternotomy, 4 - arched metal plate made in the form of a spring arcs, 5 - sternal-rib hump, 6 - sternum in the correction position, 7 - fixing the ends of the plate to the ribs.

The proposed method is as follows.

Surgery is performed under endotracheal anesthesia in the patient's position on the back. After processing the surgical field, an incision 2 is made at the base of the sternocostal hump 5, in the projection of the sternum handle, followed by a transverse sternotomy 3 bit (Fig. 1, 2). Then perform contrapertural approaches 1 (Figure 1) along the lateral surfaces of the chest at the level of the greatest protrusion of the sternocostal hump. Through the contrapertural approaches 1, a subcutaneous tunnel is formed towards each other. Then, through the subcutaneous tunnel, a metal plate 4 is made and placed in it, made in the form of a spring-loaded arc (Figs. 3, 4). After placing the plate in the formed subcutaneous tunnel, an external simultaneous compression of the sternum is carried out with the removal of keeled deformation. The sternum in the correction position is displayed at 6 in Figures 4, 5, 6. The sternal-rib complex is immobilized in the corrected position 6 by fixing the ends of the plate 7 to the ribs (Figs. 5, 6).

The essence of the proposed method is illustrated by an example of a specific implementation. Patient X., 11 years old, was admitted to the Department of General Surgery IGODKB with a diagnosis of congenital keeled chest. The department conducted a clinical and laboratory examination of the patient. According to x-ray: keeled chest, ECG: sinus rhythm with heart rate of 78-92 beats per minute, respiratory arrhythmia. The electrical axis of the heart is upright. Incomplete blockade of the bundle of the right leg of Hiss. ECHO KG - volumetric overloads, valve, septal defects were not detected. Spirography: Violations of the ventilation ability of the lungs were not detected. JELL was 100%.

Surgical intervention: thoracoplasty, which was performed under endotracheal anesthesia, with monitoring of vital functions.

After processing the surgical field, an incision was made at the base of the sternocostal hump, in the projection of the sternum handle, followed by transverse sternotomy. Then, contrapertural approaches were made along the lateral surfaces of the chest at the level of the greatest protrusion of the sterno-rib hump. A subcutaneous tunnel was formed into which a metal plate was made and placed, made in the idea of a spring-loaded arc. After placing the plate, a simultaneous compression of the sternum was carried out with the elimination of keeled deformation. The sternal-rib complex was immobilized in the corrected position by this plate, the ends of which are fixed by wire to the ribs. The front chest wall at the same time assumed a physiological position. Wounds at the sites of plates and sternotomy are sutured. Blood loss was 20 ml.

The early postoperative period is smooth. Pain is not pronounced. On the 2nd day, the patient was activated, began to walk independently, serve himself. The time spent by the child in the hospital was limited to the time before the stitches were removed, i.e. 8 days. Patient X. with recovery was discharged to honey. a pause with being under dynamic observation.

Metal removal through the “old” postoperative scars was performed 1 year after the first stage of surgical intervention.

Control examination once a quarter. Parents are satisfied with the shape of the chest. Objectively: the deformation of the sterno-costal complex is completely eliminated, the rib cage has the correct shape. Postoperative scars on the lateral surfaces of the chest are pale pink and do not “catch the eye”. Parents noted in the child an improvement in their overall psychoemotional status.

No relapse was observed 1 year after the end of treatment.

In this way, 6 patients were treated; in all cases of relapse, no deformation was noted.

Thus, the proposed method can be used to treat congenital keeled chest deformity in children of all ages.

The proposed method for the surgical treatment of congenital keeled chest deformity in children provides simultaneous elimination of the sterno-rib complex defect, its stable fixation in a given position, improves the patient's quality of life after the first stage of treatment and allows to obtain a good cosmetic effect.

Claims (1)

A method of treating congenital keeled chest deformity in children, including performing a transverse sternotomy, characterized in that the transverse sternotomy is performed at the base of the sternum curvature, then at the level of the greatest protrusion of the sternocostal hump, on the lateral surfaces of the chest are applied contrapertural accesses, through which towards each other a subcutaneous tunnel is formed to a friend, in which a metal plate is placed, made in the form of a spring arc, after which simultaneous compression is performed ins and immobilization sternocostal complex with fixing plate to the ends of the ribs.

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