Evaluation of the effectiveness of a differential approach to the treatment of chest deformities
Authors:   National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Batpen Arman , Abilmazhinov Mukhtar ,   Astana Medical University, Tazhin Kairat ,   National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Кazbekov Аblaikhan ,   National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov
Published: December 2024

Currently, the issue of treating chest deformities remains relevant due to their variability. The aim of this study was to analyze the results of treatment of patients with various chest deformities for the period from 2010 to 2022.Methods. During the period from 2010 to 2022, 347 patients with chest deformities were operated in the Orthopedics Department No.2 of the National сenter of traumatology and orthopedics named after Academician N.D. Batpenov: 230 patients with funnel–shaped deformity (66.3%), 70 patients with keel-shaped deformity (20.2%), 15 with local deformities patients (4.3%), with syndromic pathologies – 10 patients (2.9%), with recurrent funnel–shaped chest deformity - 22 patients (6.3%). The average age of the patients was 18±2.4 years. There were 117 (50.9%) patients with grade II chest deformity, 113 (49.1%) with grade III. Patients with the manubriocostal type of keeled chest deformity – 5 (7.1%), 65 patients with the corporocostal type. Among the syndromic forms of diseases in which chest deformities occur were patients with Poland syndrome and Marfan syndrome.
Results. Patients with funnel–shaped deformity of the chest under the age of 16 were given open thoracoplasty according to Nass, patients over 16 years old received thoracoplasty according to Ravich with the installation of a sternocostal plate. Patients with the manubriocostal type of keeled deformity underwent open thoracoplasty with corrective osteotomy of the sternum and its subsequent fixation with a blocked plate, with the corporocostal type - open thoracoplasty without the use of metal structures. Patients with local chest deformities, as well as patients with syndromic pathologies, underwent open thoracoplasty with the installation of spoke-frame structures. Patients with recurrent funnel-shaped chest deformity underwent open thoracoplasty with the installation of a sternocostal plate. The average duration of hospitalization was 7.2±1.4 days. There were no fatalities. Hemothorax was observed in 25 (4.3%) patients, and pleural drainage was required in 10 (2.9%) cases. Pneumothorax was diagnosed in 11 (3.2%) patients, and therefore there was a need for drainage into the pleural cavity. Plate displacement was observed in 1 (0.3%) patients. Installed metal structures were removed in 200 (57.6%) patients. The average shelf life of the plate is 24.4±4.5 months. A good cosmetic result was obtained in 95% of patients.Conclusion. Thus, the treatment of various chest deformities requires an individual treatment approach. The differential approach to treatment developed by us can significantly help the doctor with determining the tactics of treating a particular chest deformity.