Funnel chest deformity (ICDgives it the code Q67.6) is a hollow chest, which is a congenital developmental anomaly, in which the sternum sinks along with the front ribs. The etiology of this deviation has not yet been finally established, but today it is assumed that hereditary factors play the leading role. The main reason is connective tissue dysplasia, and in addition, cartilage tissue in the chest.
What is the danger?
This pathology may be further aggravated byas the child grows up, often causing changes in posture, as well as heart and lung diseases. The diagnosis of this deviation is made on the basis of the examination, information of thoracometry, as well as based on the results of X-ray and other studies. Therapeutic methods of treatment, unfortunately, are ineffective. Against the background of the progression of pathology and disorders of the chest organs, doctors prescribe surgery. In more detail about the funnel-shaped deformation of the chest, its causes, symptoms and treatment, we describe below.
Description of the disease
Воронкообразная грудь, как уже отмечалось, is a congenital pathology, which is associated with the recession of the anterior thoracic regions. This deviation is considered the most common among all cases of congenital chest defects. According to various sources, doctors observe such a deformity in 2.3% of the inhabitants of our country. This disease, due to its propensity to progress in a number of situations, is a serious danger to the general health of patients.
Causes of pathology
Etiology of funnel chest deformitycells, unfortunately, have not yet been completely clarified. In this regard, at the present time, experts consider about thirty hypotheses of the formation of a funnel chest. True, it was statistically established that hereditary factors have a leading role in the development of this pathology. This theory is confirmed by the presence of sick relatives with absolutely identical congenital malformations. In addition, in patients with a funnel chest, more developmental abnormalities are much more common than in other people.
Dysplasia
The main cause of the presented strainacts cartilage, and in addition, connective tissue dysplasia, which occurs due to some enzymatic disorders. The inferiority of the tissue can manifest itself not only before the birth of the child, but also in the process of his further maturation. With age, breast retraction can often progress, as a result of which spinal curvature occurs along with a decrease in the volume of the thoracic cavity, displacement of the heart and dysfunction of all organs in the area. Histological studies of cartilage tissue, which was taken from patients of different ages, confirmed the aggravation of changes. For example, as the cartilage grows, it can loosen up more and more, an excessive amount of intercellular substance occurs in it and the formation of numerous cavities and foci of asbestos degeneration occurs.
Classification of pathology
Currently, experts describe aboutforty syndromes that are accompanied by the formation of funnel chest deformity. But the absence of a single pathogenetic theory of the development of the disease, with which everyone would agree, makes it difficult to create a single classification. The most successful option, which applies the majority of modern doctors today, is the classification Kondrashin. So, according to her, this pathology is classified as follows:
- According to the shape of the deformity, the disease can be asymmetrical or symmetrical.
- According to the shape of the deformity, the disease is flat-crowned and common.
- According to the type of deformity of the sternum, pathology can be typical, saddle or screw.
- According to the degree of deformation, the first, second, and third degree of funnel chest deformation are distinguished.
- At the stage of the disease is compensated, subcompensated or decompensated.
- By combining with the other congenital anomalies, this disease can be unmatched and combined.
Gizhitskaya method
To determine the degree of development of this formchest in Russian traumatology and orthopedics use the Gizhitskaya method. As part of its application, the smallest and largest distance between the front surface of the spine and the sternum is measured on the lateral radiograph. Further, the smallest distance is divided by the greatest, and thus the final strain coefficient is obtained. The indicator “0.7” and more indicates the first degree, “0.5” indicates the second, and even lower indicates the third.
Symptomatology
Manifestations of this form of the chest directlydepend on the age of the patients. In infants, a slight depression of the sternum is observed. In addition, there is also paradoxical breathing, with this symptom of the rib with the sternum sink at the moment of inhalation. Among younger patients, the indentation of the sternum is more pronounced, and a transverse sulcus can be found directly under the edges of the costal arches. Preschoolers diagnosed with a funnel chest more often than other peers suffer from colds.
Impaired posture in schoolchildren
Помимо всего прочего у школьников с этим a diagnosis reveals a violation of posture. The process of curvature of the ribs and sternum becomes fixed. At the same time, the thorax looks flattened, the upper arms are lowered, the edges of the rib arches are raised, and the stomach is bulged forward. Symptoms of paradoxical respiration may gradually disappear as they mature. See thoracic kyphosis, which often occurs in combination with scoliosis.
Other signs
Also with funnel chest deformitycells in children may be marked by fatigue along with sweating, irritability, decreased appetite, pallor of the skin and weight loss in comparison with the age norm. Such children can endure physical exertion extremely poorly. In addition, they have some kind of impairment in the work of the heart and lungs. They are characterized by frequent bronchitis with pneumonia, and some patients may complain of pain in the region of the heart.
Diagnosing the presence of strain
Обследование пациентов с таким отклонением, как funnel chest, involves accurate diagnosis, along with an assessment of the general condition of the patient. As part of the diagnosis, an important role is played by the severity of disorders of the heart, as well as the lungs. As a rule, the diagnosis does not cause any difficulties at the stage of the first inspection. To assess the degree of deformity, thorakometry and various indices are used, which are determined taking into account the volume of the cavity in the region of the sternum along with the elasticity of the cell, its width and some other indicators. In order to clarify the information of thoracometry, chest x-rays are performed in two projections and computed tomography of the organs in the cavity is performed.
Respiratory System Studies
Помимо всего прочего больного с врожденной funnel chest deformities are referred to a pulmonologist and a cardiologist, prescribing a number of different studies of the respiratory system. Spirometry confirms a decrease in lung capacity. On the electrocardiogram reveal the displacement of the axis of the heart. Echocardiography often reveals mitral valve prolapse. In addition, patients with such deformation often observe tachycardia with an increase in venous pressure and other disorders. As practice shows, with age, the pathological manifestation becomes more clear and pronounced.
Treatment of pathology
Funnel Breast Therapy maybe carried out by traumatologists, orthopedists and thoracic surgeons. Conservative treatment for this disease is ineffective. Indications for surgery are increasing violations of the circulatory and respiratory organs. In addition, sometimes surgery is carried out to eliminate the cosmetic defect. LFK is very effective in funnel-shaped deformation of the chest.
Early surgery
Operations recommend to carry out mainlyat an early age, the optimal period for this is six years. Such an approach makes it possible to provide conditions for healthy formation of the chest, preventing the development of secondary spinal deformity along with the appearance of any functional impairment. In addition, children are much easier to undergo surgery, since their chest is more elastic, and therefore the correction is not so traumatic.
Currently, doctors use aboutfifty options for surgical interventions in the treatment of funnel chest deformity. All methods are divided into two categories: palliative and radical. The purpose of the radical technique is to increase the chest. This method involves the dissection of the sternum and the cartilaginous part of the ribs. During this operation, part of the bone is removed, and the anterior sections of the cell are fixed with the help of special stitches and various fixers, for example, knitting needles or plates and so on. Palliative intervention involves masking the defect without adjusting the volume of the chest area. At the same time, silicone prostheses are sewn into the defective space.
Third degree
Indisputable indication for radicalsurgery is the presence of funnel chest deformation of the third degree. Before surgery, patients must be prescribed a comprehensive examination and treat various chronic infectious diseases, such as, for example, bronchitis, sinusitis, chronic pneumonia, and the like.
Показанием к паллиативной методике вмешательства serves the first and second degree of deformation. Palliative surgery is performed only on adults, since in the process of development of the child’s body, a silicone prosthesis is able to visually exfoliate and the cosmetic effect of the operation will be lost. Patients older than thirteen years with the presence of a slight deformation can carry out the correction of the position of costal arcs. In the framework of this operation, the arcs are cut off and crosswise fixed on the front sternum surface.
In order to create the most comfortable conditions inpostoperative time, the patient is sent to the intensive care unit, which is in a state of medical sleep. Against this background, they carefully monitor the organs of the chest cavity, and in addition, the functions of the respiratory system. To prevent hypoxia, oxygen is inhaled with a nasal catheter. From the second day begin breathing exercises, and a week later - physical therapy with a massage.
What is the effectiveness of surgery for funnel chest deformity?
Results of surgery
Оценить результаты операции удастся лишь спустя half a year At the same time, the cosmetic effect is evaluated along with the degree of restoration of the functional activity of the chest organs. As part of this, it is considered a good result to completely eliminate the funnel chest along with the absence of paradoxical breathing and the compliance of the anthropometric indicator with the standard figures for a particular age. In addition, there should be no violation of the work of the heart, and in addition, normal indicators of acid and salt metabolism should be recorded.
Conclusion
Doctors consider satisfactory the result, withwhich remains a slight deformation along with modest functional impairment, but as such there are no complaints. An unsatisfactory result will be a recurrence of the deformity with preservation of complaints that the functional parameters have not improved in any way. As a rule, a good result is achieved in 50% of patients, satisfactory - in 25%, and unsatisfactory - in 10%. According to research data, the best results are observed against the background of the sternum plastics without the use of clamps. But it is important to note that at the moment there is no single universal method that would be equally well suited to absolutely all patients.
Do you have chest funnel deformity?cells in the army? It depends on the type and severity of the pathology. If this resulted in respiratory insufficiency of at least second degree, then conscription is excluded.
