Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, People's Republic of China.
J Cardiothorac Surg. 2022 Oct 20;17(1):271. doi: 10.1186/s13019-022-02021-3.
The Nuss bar is commonly used for minimally invasive correction of pectus excavatum and is usually removed within 2-3 years. Here, we report a case of 10-year bar placement after the Nuss procedure accompanied by unique complications of thoracic malformation that have not been described before. The asymmetric pectus carinatum caused by bar displacement and significant rib periosteal hyperplasia is described for the first time.
A 23-year-old man was admitted to our hospital due to the main complaint of obvious chest discomfort when lifting heavy weights. The bar removal was seriously delayed due to his loss to follow-up. Chest asymmetry and distant heart sounds were found during a physical examination. A chest CT scan demonstrated that the right end of the lower bar originally fixed outside the ribs had shifted into the thoracic cavity, and the left costal cartilage was obviously protruding. Additionally, the displaced bars were separated from the sternum and tightly attached to the pericardium, resulting in abnormalities of the anterior mediastinum. These secondary thoracic deformities made the patient extremely prone to massive hemorrhage or multiple rib fractures when sliding the bars out. However, serious consequences were avoided due to reasonable adjustments to the usual bar removal procedures.
This case demonstrates a specific type of bar displacement caused by prolonged placement of the bars and highlights the importance of rigorous follow-up of patients after the Nuss procedure.
Nuss 矫正棒常用于微创矫正漏斗胸，通常在 2-3 年内取出。在这里，我们报告了一例 Nuss 手术后 10 年放置矫正棒的病例，伴有以前未描述过的独特的胸廓畸形并发症。描述了首次出现的由矫正棒移位引起的不对称鸡胸畸形和明显的肋骨骨膜增生。
一名 23 岁男性因举重时明显胸痛的主要诉求而入院。由于失访，他的矫正棒取出严重延迟。体格检查发现胸廓不对称和心音遥远。胸部 CT 扫描显示原本固定在肋骨外的下矫正棒的右端已移位到胸腔内，左侧肋软骨明显突出。此外，移位的矫正棒与胸骨分离，并紧紧附着于心包膜，导致前纵隔异常。这些继发性的胸廓畸形使得在滑动矫正棒时，患者极易发生大量出血或多发性肋骨骨折。然而，由于对 Nuss 手术后的常规矫正棒取出程序进行了合理的调整，严重后果得以避免。
本病例显示了一种特殊类型的矫正棒移位，由矫正棒的长时间放置引起，并强调了 Nuss 手术后对患者进行严格随访的重要性。
