Does the modelling of the pectus bar affect its stability? Rationale for using a short flat bar.


  • 影响因子:1.39
  • DOI:10.1093/icvts/ivz217
  • 作者列表:"Pérez D","Martel O","Yánez A","Cano JR","Cuadrado A","Torrent G","López L
  • 发表时间:2020-01-01

OBJECTIVES:Although the Nuss procedure for pectus excavatum is still associated with a non-negligible risk of postoperative bar displacement, the potential effects of the length and shape of the bar on its corrective ability and stability have not been sufficiently studied. The aim of this study was to determine how the modelling of the pectus bar affects its stability and whether an alternative configuration of the implant can improve clinical success. METHODS:Simulated implantation of bars with different shapes and sizes in a computational model was carried out. A 250 N sternal force was applied to the bars, and the resulting forces and moments on the fixation points were identified. Afterwards, a clinical trial was carried out in a group of patients with pectus excavatum, some of whom received long inverted U-shaped bars and some of whom received implants designed from the computational results. RESULTS:When U-shaped bars were tested, the sternal force generated unbalanced horizontal reaction forces (16 vs 61 N) and large reaction moments at the ends of the bar, conferring the tendency to slide and to rotate, respectively. No lateral or rotational destabilizing forces occurred in the case of a flat bar. Cosmetic outcomes, postoperative times and hospital stays were similar in both clinical groups. However, 2 cases (2/15) of bar flipping occurred in patients who received the conventional bar. CONCLUSIONS:The shape of the bar is a determinant of its stability. A flat, shorter pectus bar provides adequate correction of the deformity with less tendency for bar displacement in the repair of pectus excavatum.


目的: 尽管Nuss手术治疗漏斗胸仍然与术后棒移位的不可忽略的风险相关,杆的长度和形状对其校正能力和稳定性的潜在影响尚未得到充分研究。本研究的目的是确定果胶棒的建模如何影响其稳定性,以及植入物的替代配置是否可以提高临床成功率。 方法: 在计算模型中模拟植入不同形状和大小的棒材。对杆施加 250 n胸骨力,确定固定点上的力和力矩。随后,在一组漏斗胸患者中进行了临床试验,其中一些患者接受了长倒U形棒,一些患者接受了根据计算结果设计的植入物。 结果: 测试U形杆时,胸骨力在杆端产生不平衡水平反作用力 (16 vs 61  N) 和大反作用力力矩,分别赋予滑动和旋转的倾向。在扁杆的情况下,没有发生横向或旋转不稳定力。两个临床组的美容结局、术后时间和住院时间相似。然而,在接受常规酒吧的患者中发生酒吧翻转 2 例 (2/15)。 结论: 杆件的形状是其稳定性的决定因素。平坦、较短的漏斗胸棒在漏斗胸修复中提供了足够的畸形矫正,较少出现棒移位的趋势。



作者列表:["Peyroux E","Babinet MN","Cannarsa C","Madelaine C","Favre E","Demily C","Michael GA"]

METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.

作者列表:["Sheridan GA","Nagle M","Howells C","Gallagher O","Kiely PJ","O'Toole P","Kelly PM","Moore DP"]

METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.

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作者列表:["Grigoryan G","Korcek L","Eidelman M","Paley D","Nelson S"]

METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.

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