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Surgical treatment of sternal deformity in children

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  • Save American Journal of Medicine and Medical Sciences 2021, 11(6): 490-494 DOI: 10.5923/j.ajmms.20211106.06 Results of Surgical Treatment of Keel Deformation of the Chest in Children Mirzakarimov B.*, Dzhumabaev J., Kodirov K. Department Pediatric Surgery, Andijan State Medical Institute, Andijan, Uzbekistan Abstract Chest deformities in children are pathological changes in the shape, volume and size of the chest that leads to lengthening or shortening of the distance between the sternum and spine and, as a result, leading to a violation of the topography of internal organs. Chest deformities occur in 1-4% of the population. Among children (especially boys) this figure is 0.6-2.3%, characterized mainly by a cosmetic defect of the chest, functional disorders of the cardiovascular system and respiratory system, as well as mental disorders. Therefore, chest deformities are included in the group of urgent problems of pediatric thoracic surgery, traumatology and orthopedics, cardiology and psychology. Keywords Keeled deformity, Reconstructiveness, Children 1. Introduction According to the World Health Organization, 21% of all developmental anomalies occur in the musculoskeletal system [1,2,5,9,10,12], which means that 18 out of every 10,000 children are born with congenital malformations, and in 18.5% of cases they are disabled [6,13,15]. One of the most common types of these anomalies is keel deformity (KCHD), which is accompanied not only by cosmetic defects, but also by functional disorders of the chest cavity organs. To date, more than 100 methods and their modifications have been developed and applied for chest deformities [1,3,4,7,11,16]. Such an abundance of methods confirms the relevance and complexity of the problem of pediatric surgery and orthopedics and makes us look for scientifically grounded approaches in the treatment of this category of children [2,3,9,14,16]. 2. Objective To study and compare the results of surgical treatment of keeled chest deformities. 3. Materials and Methods of Research In the department of thoracic surgery of the Andijan regional children's multidisciplinary medical center, the results of treatment of 180 children operated on with a * Corresponding author: (Mirzakarimov B.) Received: May 26, 2021; Accepted: Jun. 16, 2021; Published: Jun. 26, 2021 Published online at diagnosis of CDC were studied. When studying the clinical data, the scheme of age periods was used by N.P. Gundobin (1906) for the classification of patients by age group. The patients were divided into age groups as follows; 38 (21.1%) children aged 3-7 years, 62 (34.4%) children aged 7-12 years and 80 (44.4%) children aged 12-18 years. When the frequency of the disease was determined by sex, this pathology was found in boys more often than 68 (37.8%) in girls, 112 (61.4%) in boys. The examination of disease in children in 30 (17%) patients manubriocostal, in 99 (55%) corporocostal, and 51 (28%) costal type were diagnosed. The degree of the disease was determined according to the method of V.Shamik (2003) on a lateral chest radiograph. Patients with grade I deformity of surgical treatment were not enrolled. Disease II degree was observed in 71 (39.4%) patients, III degree - in 109 (60.6%) patients. All patients underwent general clinical laboratory, X-ray, ECG and EchoKG, spirographic examinations and examinations of pediatricians, cardiologists, ENT specialists as preoperative preparation. In patients with the functional state of the respiratory system of children examined by spirographic audit, the defect passed level II r Mats revealed that this is a relative indicator in patients (84.2%), patients of level III with mild deviations (71.4%) were not identified. According to the results of the study of the Typhno index in children with KCHD, no limitation of external respiration was revealed. According to the results of Spirographic KCHD only in the early stages of the disease, as a cosmetic defect, the child's age increases as the degree of deformity increases until the volume of the chest and lungs increases and leads to stretching, the rate of breathing of the child. - the maximum decrease in volume. ECG examinations revealed that metabolic changes in the heart muscles were detected in 32% of patients, left ventricular hypertrophy was detected American Journal of Medicine and Medical Sciences 2021, 11(6): 490-494 491 in 15.3% of patients, right ventricular hypertrophy was revealed in 21.3% of children, and incomplete left ventricular block legs of the bundle of Giss was revealed in 31.4% of patients.. Of the cardiac arrhythmias, sinus bradycardia occurs in 18.5% of patients, sinus tachycardia occurs in 34.6%, and the remaining 46.9% of patients have no cardiac arrhythmias. It was studied as a primary and control group to study the effectiveness of surgical treatment. The control group consisted of 76 (42.2%) patients treated according to the Bairov [2] method with a diagnosis of KCHD in 2010-2015, and the main group consisted of 104 (57.8%) patients treated with the proposed reconstructive method in 2015-2020. 4. Examination Results The results of surgical treatment in 3 periods, the duration of the operation, the early and long postoperative periods were studied. When comparing the results during surgery, both groups of patients were analyzed on the basis of complications such as bleeding, pleural trauma, pneumothorax. Comparative analysis of complications in patients during surgery is presented in Table 1. It is statistically significant that the complications observed during surgery with CCD decreased from 23.4% to 5.7% in the main group of patients compared with the control group, where bleeding was more frequent during the analytical study, r <0.05. It was also found that the damage to the pleura as a result of the separation of the thoracic-costal complex (HRC) from the parietal pleura decreased by 2 times (from 15.5% to 7.6%). Pneumothorax, which could occur during the operation and in the following days, was not observed in the main group, while in the control group this indicator was 9.2%. Analysis of complications during surgery, the presence of complications was 48.7%, in the control group there were patients of the main group, 13.4%, statistically significant (p <0.01). The next postoperative period was examined up to 3 months from the moment of admission of the patient to intensive care. A comparative analysis of the surgical treatment of complications observed in the early period is presented in Table 2. In the method of surgical treatment of Bairov's KCHD, a soft bandage with an adhesive plaster under external pressure was used to hold the CDC in the correct position after surgery. Retention of the HRC in various equipment and ligaments after surgery with KCHD can cause various discomfort and painful sensations in the patient for a certain period of time. Table 2 shows that in patients of the control group, pain relief with narcotic analgesics (4.2 ± 0.57 days) and non-narcotic analgesics lasted 7.1 ± 0.59 days, while in the main group of patients after the proposed method of reconstructive surgery, only 2, 01 ± 0,21 d. Postoperative chest pain in the main group was 2.5 times less than in the control (from 8.2 ± 0.57 to 3.0 ± 0.13 days). In the main group of patients, from the first day, it was allowed to sit in an upright position. However, in the control group, patients were allowed 3.6 ± 0.24 days due to persistent chest pain. Patients were also allowed to walk at a slower speed (5.2 ± 0.54) compared to 2.2 ± 0.12 days in the main group than in the control group. Secondary relapses of surgical trauma occurred in both groups with the same percentage (7.8% and 7.7%). Reducing the duration of pain and pain in patients using the proposed method of reconstructive surgery, in the main group of patients, as mentioned above, allows patients to move to an early horizontal position, walk 2.2 ± 0.12 days, hospitalization by 12.2 ± 0, 64 days 7 D decreases by 3 ± 0.16 days. This aspect of the outcome of surgical treatment has demonstrated the cost-effectiveness of reconstructive surgery. Table 1. Comparative analysis of surgical complications in patients with a diagnosis of KCHD No. Complication type Control group n = 7 6 press % Main group n = 1 04 press % 1 Bleeding 18 23.4 ± 9.9 * 6 5.7 ± 9.5 * 2 Pleural injury 12 15.5 ± 10.4 8 7.6 ± 9.4 3 Pneumothorax 7 9.2 ± 10.9 - - Total 37 48.7 ± 8.2 ** 14 13.4 ± 9.1 ** * * - r <0.01 statistically different from the control group Table 2. Comparison of Surgical Treatment by Criteria for Evaluating the Early Stage of Complications No. Criteria for evaluation Control group n = 7 6 Main group n = 1 04 1 Pain relief with narcotic analgesics 4.2 ± 0.57 days 1.3 ± 0.16 days 2 Pain relief with non-narcotic analgesics 7.1 ± 0.59 days 2.01 ± 0.21 days 3 Duration of pain 8.2 ± 0.57 days 3.0 ± 0.13 days 4 Place the patient in an upright position 3.6 ± 0.24 days 1.4 ± 0.1 days 5 Allow to walk 5.4 ± 0.54 days 2.2 ± 0.12 days 6 Duration of treatment 12.2 ± 0.64 days 7.3 ± 0.16 days 492 Mirzakarimov B. et al.: Results of Surgical Treatment of Keel Deformation of the Chest in Children Table 3. Criteria for assessing long-term outcomes in patients with CKD treated with surgery No. Criteria for evaluation Ball a) No complains 10 one Feeling tired b) fatigue during physical exertion 5 c) quick fatigue 1 a) No complaints 10 2 Dyspnea b) Inhalation with moderate physical activity 5 c) Inhalation with light exercise 1 a) no 10 3 Presence of intercostal neuralgia b) pain during physical exertion 5 c) pain with constant deep breathing 1 a) You will notice that the scar is thin 10 4 Postoperative scar condition b) scar bruise 5 c) keloid scar 1 a) no 10 5 The presence of postoperative khodrom b) 0.5 cm 5 c) more than 0.5 cm 1 a) no 10 6 Displacement of the ends of the resected tubes b) one edge 5 c) two or more 1 a) in moderation 10 7 Breast shape b) limited deformation in the ribs 5 c) repetition 1 good 10 8 Postoperative physical development b) average 5 v ) past 1 a) enterprising 10 9 Psychological condition b) shy 5 c) angry 1 a) flat 10 10 X-ray examination result b) deformation of the I degree 5 c) repeats 1 KDGK surgical treatment of patients with a diagnosis of long-term results of treatment in the main group 86 and the control group of 54 examined patients. Due to the difficulty of generalizing long-term postoperative outcomes in patients, all aspects of treatment outcomes were included in the evaluation criteria. The criteria were based on the cosmetic outcome of the operation, functional changes in the respiratory system, physical development of the child, X-ray changes in the chest, postoperative psychological state of the patient. Long-term results of patients were assessed using the evaluation criteria listed in Table 3. Each selected criterion was divided into groups, marked with scores for the indicators. When assessing the general condition of the patients, the conclusions of himself and his parents, the mental state of the patient, physical activity, and the general condition that improved after the operation were taken into account. Patient outcomes were scored on a scoring system and were rated as good on a scale of 100 to 80, satisfactory on a scale of 79 to 50, and unsatisfactory on a scale of >50. The distribution of patients by the number of points according to the assessment criteria is shown in Figure 1. When dividing patients by points, patients with a score of 100-80 points in the main group showed a 2.7-fold increase in comparison with the control group, r <0.001. Patients with scores 79-50 scored 4 (4.6%) in the main group and 13 (24.1%) in the control group. The diagram also shows that if an unsatisfactory score (>50) was detected in 11 (20.4%) patients of the control group, then this indicator was not observed in the main group of patients. The results of treatment of patients with a diagnosis of KCHD, treated with surgery, are presented in Figure 2. American Journal of Medicine and Medical Sciences 2021, 11(6): 490-494 493 90 82 80 70 60 50 40 30 30 20 13 10 4 0 100-80 point 79-50 point 11 0 >50 C ontrol group Main group Figure 1. Patient scores by assessment criteria Main group 4,6% 95,3% Good Satisfactory Unsatisfactory Control group 0 20,4% 24,7% 55,5% Good Satisfactory Unsatisfactory Figure 2. Results of surgical treatment of patients in the main and control groups When comparing the long-term outcomes of pediatric patients with CKD, there were no recurrences of the disease in the surgical group of patients in the main group (20.4% in the control group). Good treatment outcomes also increased from 55.5% to 95.3%. Thus, the development and increase in the level of CKD was observed mainly in adolescence. Functional changes in patients are observed in the cardiovascular system more than in the respiratory system. In puberty children, surgery causes more cosmetic and psychological changes. The proposed reconstructive method of surgical treatment of CDC leads to a decrease in the number of complications by almost 2 times. 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