- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Chest Wall Surgery Professional Committee of Shaanxi Provincial Health Association, Xi'an, 710038, P. R. China;
HUANG Lijun,
Email: tuodi1986@126.com
[Abstract]Pectus excavatum (PE) is a common congenital chest malformation in children, manifested by inward depression of the anteriorthorax wall, which can compress the normal tissues and organs in the chest and cause adverse effects on the physiology and psychology of patients. Surgery is the most important means of treating PE, and with the invention of Nuss surgery, the surgical treatment of PE has entered the minimally invasive era. At present, there are many indexes to evaluate the severity of thoracic malformations in PE patients, and selecting appropriate evaluation indexes is of great significance for the formulation of surgical protocols. As a physical and mental disease, PE's deformed thoracic appearance will not only affect the function of thoracic organs, but also affect the psychological state of patients. Therefore, there is still controversy over whether the role of orthopedic surgery is to improve function or cosmetic plastic surgery. At the same time, the orthopedic efficacy and postoperative complications of the existing modified and novel surgical methods need to be further observed and evaluated. In addition, the design of surgical plan and the selection of surgical timing for PE combined with other diseases are also critical and controversial issues in clinical practice. Therefore, this article explores and reviews the controversial points in the current surgical treatment of PE.
| 1. | Kelly RE, Lawson ML, Paidas CN, et al. Pectus excavatum in a 112-year autopsy series: Anatomic findings and the effect on survival. J Pediatr Surg, 2005, 40(8): 1275-1278. |
| 2. | David VL. Current concepts in the etiology and pathogenesis of pectus excavatum in humans-A systematic review. J Clin Med, 2022, 11(5): 1241. |
| 3. | Zuidema WP, Oosterhuis JWA, Zijp GW, et al. Early consequences of pectus excavatum surgery on self-esteem and general quality of life. World J Surg, 2018, 42(8): 2502-2506. |
| 4. | Scalise PN, Demehri FR. The management of pectus excavatum in pediatric patients: A narrative review. Transl Pediatr, 2023, 12(2): 208-220. |
| 5. | Mortellaro VE, Iqbal CW, Fike FB, et al. The predictive value of Haller index in patients undergoing pectus bar repair for pectus excavatum. J Surg Res, 2011, 170(1): 104-106. |
| 6. | Gosztyla CE, Petrosyan M, Kane T, et al. Mini thoracic CT adequately determines Haller index and decreases radiation exposure in children with pectus excavatum. J Pediatr Surg, 2022, 57(6): 1076-1078. |
| 7. | St Peter SD, Juang D, Garey CL, et al. A novel measure for pectus excavatum: The correction index. J Pediatr Surg, 2011, 46(12): 2270-2273. |
| 8. | Ramadan S, Wilde J, Tabard-Fougère A, et al. Cardiopulmonary function in adolescent patients with pectus excavatum or carinatum. BMJ Open Respir Res, 2021, 8(1): e001020. |
| 9. | Hebal F, Port E, Hunter CJ, et al. A novel technique to measure severity of pediatric pectus excavatum using white light scanning. J Pediatr Surg, 2019, 54(4): 656-662. |
| 10. | Port E, Hebal F, Hunter CJ, et al. Measuring the impact of surgical intervention on pediatric pectus excavatum using white light scanning. J Pediatr Surg, 2019, 54(11): 2261-2267. |
| 11. | Uemura S, Yoshida A, Kuyama H. Analysis of chest wall elevation after the Nuss procedure using 3D body scanning technique in patients with pectus excavatum. Pediatr Surg Int, 2021, 37(6): 777-782. |
| 12. | Wang L, Guo T, Zhang H, et al. Three-dimensional printing flexible models: A novel technique for Nuss procedure planning of pectus excavatum repair. Ann Transl Med, 2020, 8(4): 110. |
| 13. | Gaspar P, Nunez G, Alvarez G, et al. Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. Cir Pediatr, 2021, 34(4): 186-190. |
| 14. | Kim HK, Yoon JY, Han KN, et al. Effect of the Nuss procedure on the physical development of patients with pectus excavatum. Ann Thorac Cardiovasc Surg, 2016, 22(6): 327-332. |
| 15. | Chang PY, Hsu ZY, Lai JY, et al. Increase in intrathoracic volume in pectus excavatum patients after the Nuss procedure. Med Biol Eng Comput, 2010, 48(2): 133-137. |
| 16. | Ito Y, Suzuki H, Sasahara Y, et al. Can surgical repair for pectus excavatum contribute to lung growth? Interact Cardiovasc Thorac Surg, 2021, 33(6): 928-934. |
| 17. | Kuyama H, Uemura S, Yoshida A, et al. Pulmonary function in children with Pectus excavatum and post-operative changes after nuss procedure. Pediatr Surg Int, 2018, 34(10): 1099-1103. |
| 18. | Dreher C, Reinsberg M, Oetzmann von Sochaczewski C, et al. Changes in pulmonary functions of adolescents with pectus excavatum throughout the Nuss procedure. J Pediatr Surg, 2023, 58(9): 1674-1678. |
| 19. | Zens TJ, Casar Berazaluce AM, Jenkins TM, et al. The severity of pectus excavatum defect is associated with impaired cardiopulmonary function. Ann Thorac Surg, 2022, 114(3): 1015-1021. |
| 20. | Akyüz Özkan E, Khosrashahi HE, Serin Hİ, et al. Cardiac and arterial elastance and myocardial wall stress in children with pectus excavatum. Interact Cardiovasc Thorac Surg, 2016, 23(1): 4-8. |
| 21. | Liu Q, Wang W, Hong C, et al. Effect of minimally invasive repair of pectus excavatum on postoperative chest flatness, cardiopulmonary function, and bone metabolism indexes in children at different ages. Am J Transl Res, 2022, 14(6): 3955-3963. |
| 22. | Maagaard M, Heiberg J. Improved cardiac function and exercise capacity following correction of pectus excavatum: A review of current literature. Ann Cardiothorac Surg, 2016, 5(5): 485-492. |
| 23. | Viggiano D, Bongiolatti S, Borgianni S, et al. Nuss technique for pectus excavatum in adult patients: Cosmetic satisfaction and improvement of quality of life in a single-center experience. Front Surg, 2022, 9: 903791. |
| 24. | Suehs CM, Molinari N, Bourdin A, et al. Change in cardiorespiratory parameters following surgical correction of pectus excavatum: Protocol for the historical-prospective HeartSoar cohort. BMJ Open, 2023, 13(6): e070891. |
| 25. | Ravitch MM. The operative treatment of pectus excavatum. Ann Surg, 1949, 129(4): 429-444. |
| 26. | Gotia D, Aprodu S, Savu B, et al. The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum. Rev Med Chir Soc Med Nat Iasi, 1996, 100(3-4): 169-172. |
| 27. | Fonkalsrud EW. Current management of pectus excavatum. World J Surg, 2003, 27(5): 502-508. |
| 28. | Adkins P, Gwathmey O. Pectus excavatum: an appraisal of surgical treatment. J Thorac Surg, 1958, 36(5): 714-724. |
| 29. | Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552. |
| 30. | Protopapas AD, Athanasiou T. Peri-operative data on the Nuss procedure in children with pectus excavatum: independent survey of the first 20 years' data. J Cardiothorac Surg, 2008, 3: 40. |
| 31. | de Loos ER, Daemen JHT, Pennings AJ, et al. Minimally invasive repair of pectus excavatum by the Nuss procedure: The learning curve. J Thorac Cardiovasc Surg, 2022, 163(3): 828-837. |
| 32. | Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: Past, present and future. Ann Cardiothorac Surg, 2016, 5(5): 422-433. |
| 33. | Croitoru DP, Kelly RE, Goretsky MJ, et al. The minimally invasive Nuss technique for recurrent or failed pectus excavatum repair in 50 patients. J Pediatr Surg, 2005, 40(1): 181-186. |
| 34. | Pilegaard HK, Licht PB. Early results following the Nuss operation for pectus excavatum--A single-institution experience of 383 patients. Interact Cardiovasc Thorac Surg, 2008, 7(1): 54-57. |
| 35. | Park HJ. A technique for complex pectus excavatum repair: The cross-bar technique for grand canyon type deformity (Park classification). Ann Cardiothorac Surg, 2016, 5(5): 526-527. |
| 36. | Park HJ, Kim KS, Lee S, et al. A next-generation pectus excavatum repair technique: New devices make a difference. Ann Thorac Surg, 2015, 99(2): 455-461. |
| 37. | Uemura S, Nakagawa Y, Yoshida A, et al. Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int, 2003, 19(3): 186-189. |
| 38. | Hendrickson RJ, Bensard DD, Janik JS, et al. Efficacy of left thoracoscopy and blunt mediastinal dissection during the Nuss procedure for pectus excavatum. J Pediatr Surg, 2005, 40(8): 1312-1314. |
| 39. | Clark JJ, Johnson SM. Single incision Nuss procedure for pectus excavatum. Pediatr Surg Int, 2011, 27(7): 733-736. |
| 40. | Liu JF, Zhu SH, Xu B. Early results of 18 adults, following a modified Nuss operation for recurrent pectus excavatum. Eur J Cardiothorac Surg, 2013, 43(2): 279-282. |
| 41. | Mao YZ, Tang S, Li S. Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: An updated meta-analysis. J Pediatr Surg, 2017, 52(10): 1545-1552. |
| 42. | Potaczek T, Duda S, Adamczyk J, et al. Comparison of postoperative period in patients with pectus excavatum treated with nuss technique and Ravitch technique. Ortop Traumatol Rehabil, 2015, 17(6): 577-686. |
| 43. | Papic JC, Finnell SM, Howenstein AM, et al. Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair. J Pediatr Surg, 2014, 49(6): 919-923. |
| 44. | Tikka T, Kalkat MS, Bishay E, et al. A 20-year review of pectus surgery: An analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg, 2016, 23(6): 908-913. |
| 45. | Brungardt JG, Chizek PW, Schropp KP. Adult pectus excavatum repair: national outcomes of the Nuss and Ravitch procedures. J Thorac Dis, 2021, 13(3): 1396-1402. |
| 46. | Toci GR, Davis TA, Bigelow BF, et al. Analyzing outcomes of Nuss and Ravitch repair for primary and recurrent pectus excavatum in adults. Ann Thorac Surg, 2020, 110(1): 272-275. |
| 47. | Jawitz OK, Raman V, Thibault D, et al. Complications after Ravitch versus Nuss repair of pectus excavatum: A Society of Thoracic Surgeons (STS) General Thoracic Surgery Database analysis. Surgery, 2021, 169(6): 1493-1499. |
| 48. | Harrison MR, Gonzales KD, Bratton BJ, et al. Magnetic mini-mover procedure for pectus excavatum Ⅲ: Safety and efficacy in a Food and Drug Administration-sponsored clinical trial. J Pediatr Surg, 2012, 47(1): 154-159. |
| 49. | Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg, 2005, 40(3): 496-500. |
| 50. | Rasihashemi SZ, Ramouz A. Pectus excavatum repair using Prolene polypropylene mesh. Asian Cardiovasc Thorac Ann, 2016, 24(2): 140-144. |
| 51. | Song IH, Lee SJ, Kim SS, et al. Surgical outcomes of double compression and complete fixation bar system in pectus excavatum. Ann Thorac Surg, 2018, 106(4): 1025-1031. |
| 52. | Kuyama H, Uemura S, Yoshida A. Chondrotomy and sternotomy combined with the Nuss procedure for severe asymmetric pectus excavatum: How to do it. Surg Today, 2021, 51(7): 1237-1240. |
| 53. | Li G, Jiang Z, Xiao H, et al. A novel modified Nuss procedure for pectus excavatum: a new steel bar. Ann Thorac Surg, 2015, 99(5): 1788-1792. |
| 54. | 吕方启, 吴茂军, 田茂良. 胸外悬吊固定治疗新生儿漏斗胸3例报告. 中国实用医药, 2008, 3(21): 160-161. |
| 55. | Wang W, Wang W, Long W, et al. Experience of the Wang procedure in treating pectus excavatum in two hundred fifty-six paediatric patients. Int Orthop, 2022, 46(10): 2307-2313. |
| 56. | Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252(6): 1072-1081. |
| 57. | Kelly RE, Mellins RB, Shamberger RC, et al. Multicenter study of pectus excavatum, final report: Complications, static/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg, 2013, 217(6): 1080-1089. |
| 58. | Gaspar Perez M, Nunez Garcia B, Alvarez Garcia N, et al. Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. Cir Pediatr, 2021, 34(4): 186-190. |
| 59. | Gałązka P, Leis K, Kroczek K, et al. Metal allergy after the Nuss procedure for pectus excavatum: A review. Postepy Dermatol Alergol, 2020, 37(6): 848-852. |
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- 1. Kelly RE, Lawson ML, Paidas CN, et al. Pectus excavatum in a 112-year autopsy series: Anatomic findings and the effect on survival. J Pediatr Surg, 2005, 40(8): 1275-1278.
- 2. David VL. Current concepts in the etiology and pathogenesis of pectus excavatum in humans-A systematic review. J Clin Med, 2022, 11(5): 1241.
- 3. Zuidema WP, Oosterhuis JWA, Zijp GW, et al. Early consequences of pectus excavatum surgery on self-esteem and general quality of life. World J Surg, 2018, 42(8): 2502-2506.
- 4. Scalise PN, Demehri FR. The management of pectus excavatum in pediatric patients: A narrative review. Transl Pediatr, 2023, 12(2): 208-220.
- 5. Mortellaro VE, Iqbal CW, Fike FB, et al. The predictive value of Haller index in patients undergoing pectus bar repair for pectus excavatum. J Surg Res, 2011, 170(1): 104-106.
- 6. Gosztyla CE, Petrosyan M, Kane T, et al. Mini thoracic CT adequately determines Haller index and decreases radiation exposure in children with pectus excavatum. J Pediatr Surg, 2022, 57(6): 1076-1078.
- 7. St Peter SD, Juang D, Garey CL, et al. A novel measure for pectus excavatum: The correction index. J Pediatr Surg, 2011, 46(12): 2270-2273.
- 8. Ramadan S, Wilde J, Tabard-Fougère A, et al. Cardiopulmonary function in adolescent patients with pectus excavatum or carinatum. BMJ Open Respir Res, 2021, 8(1): e001020.
- 9. Hebal F, Port E, Hunter CJ, et al. A novel technique to measure severity of pediatric pectus excavatum using white light scanning. J Pediatr Surg, 2019, 54(4): 656-662.
- 10. Port E, Hebal F, Hunter CJ, et al. Measuring the impact of surgical intervention on pediatric pectus excavatum using white light scanning. J Pediatr Surg, 2019, 54(11): 2261-2267.
- 11. Uemura S, Yoshida A, Kuyama H. Analysis of chest wall elevation after the Nuss procedure using 3D body scanning technique in patients with pectus excavatum. Pediatr Surg Int, 2021, 37(6): 777-782.
- 12. Wang L, Guo T, Zhang H, et al. Three-dimensional printing flexible models: A novel technique for Nuss procedure planning of pectus excavatum repair. Ann Transl Med, 2020, 8(4): 110.
- 13. Gaspar P, Nunez G, Alvarez G, et al. Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. Cir Pediatr, 2021, 34(4): 186-190.
- 14. Kim HK, Yoon JY, Han KN, et al. Effect of the Nuss procedure on the physical development of patients with pectus excavatum. Ann Thorac Cardiovasc Surg, 2016, 22(6): 327-332.
- 15. Chang PY, Hsu ZY, Lai JY, et al. Increase in intrathoracic volume in pectus excavatum patients after the Nuss procedure. Med Biol Eng Comput, 2010, 48(2): 133-137.
- 16. Ito Y, Suzuki H, Sasahara Y, et al. Can surgical repair for pectus excavatum contribute to lung growth? Interact Cardiovasc Thorac Surg, 2021, 33(6): 928-934.
- 17. Kuyama H, Uemura S, Yoshida A, et al. Pulmonary function in children with Pectus excavatum and post-operative changes after nuss procedure. Pediatr Surg Int, 2018, 34(10): 1099-1103.
- 18. Dreher C, Reinsberg M, Oetzmann von Sochaczewski C, et al. Changes in pulmonary functions of adolescents with pectus excavatum throughout the Nuss procedure. J Pediatr Surg, 2023, 58(9): 1674-1678.
- 19. Zens TJ, Casar Berazaluce AM, Jenkins TM, et al. The severity of pectus excavatum defect is associated with impaired cardiopulmonary function. Ann Thorac Surg, 2022, 114(3): 1015-1021.
- 20. Akyüz Özkan E, Khosrashahi HE, Serin Hİ, et al. Cardiac and arterial elastance and myocardial wall stress in children with pectus excavatum. Interact Cardiovasc Thorac Surg, 2016, 23(1): 4-8.
- 21. Liu Q, Wang W, Hong C, et al. Effect of minimally invasive repair of pectus excavatum on postoperative chest flatness, cardiopulmonary function, and bone metabolism indexes in children at different ages. Am J Transl Res, 2022, 14(6): 3955-3963.
- 22. Maagaard M, Heiberg J. Improved cardiac function and exercise capacity following correction of pectus excavatum: A review of current literature. Ann Cardiothorac Surg, 2016, 5(5): 485-492.
- 23. Viggiano D, Bongiolatti S, Borgianni S, et al. Nuss technique for pectus excavatum in adult patients: Cosmetic satisfaction and improvement of quality of life in a single-center experience. Front Surg, 2022, 9: 903791.
- 24. Suehs CM, Molinari N, Bourdin A, et al. Change in cardiorespiratory parameters following surgical correction of pectus excavatum: Protocol for the historical-prospective HeartSoar cohort. BMJ Open, 2023, 13(6): e070891.
- 25. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg, 1949, 129(4): 429-444.
- 26. Gotia D, Aprodu S, Savu B, et al. The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum. Rev Med Chir Soc Med Nat Iasi, 1996, 100(3-4): 169-172.
- 27. Fonkalsrud EW. Current management of pectus excavatum. World J Surg, 2003, 27(5): 502-508.
- 28. Adkins P, Gwathmey O. Pectus excavatum: an appraisal of surgical treatment. J Thorac Surg, 1958, 36(5): 714-724.
- 29. Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
- 30. Protopapas AD, Athanasiou T. Peri-operative data on the Nuss procedure in children with pectus excavatum: independent survey of the first 20 years' data. J Cardiothorac Surg, 2008, 3: 40.
- 31. de Loos ER, Daemen JHT, Pennings AJ, et al. Minimally invasive repair of pectus excavatum by the Nuss procedure: The learning curve. J Thorac Cardiovasc Surg, 2022, 163(3): 828-837.
- 32. Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: Past, present and future. Ann Cardiothorac Surg, 2016, 5(5): 422-433.
- 33. Croitoru DP, Kelly RE, Goretsky MJ, et al. The minimally invasive Nuss technique for recurrent or failed pectus excavatum repair in 50 patients. J Pediatr Surg, 2005, 40(1): 181-186.
- 34. Pilegaard HK, Licht PB. Early results following the Nuss operation for pectus excavatum--A single-institution experience of 383 patients. Interact Cardiovasc Thorac Surg, 2008, 7(1): 54-57.
- 35. Park HJ. A technique for complex pectus excavatum repair: The cross-bar technique for grand canyon type deformity (Park classification). Ann Cardiothorac Surg, 2016, 5(5): 526-527.
- 36. Park HJ, Kim KS, Lee S, et al. A next-generation pectus excavatum repair technique: New devices make a difference. Ann Thorac Surg, 2015, 99(2): 455-461.
- 37. Uemura S, Nakagawa Y, Yoshida A, et al. Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int, 2003, 19(3): 186-189.
- 38. Hendrickson RJ, Bensard DD, Janik JS, et al. Efficacy of left thoracoscopy and blunt mediastinal dissection during the Nuss procedure for pectus excavatum. J Pediatr Surg, 2005, 40(8): 1312-1314.
- 39. Clark JJ, Johnson SM. Single incision Nuss procedure for pectus excavatum. Pediatr Surg Int, 2011, 27(7): 733-736.
- 40. Liu JF, Zhu SH, Xu B. Early results of 18 adults, following a modified Nuss operation for recurrent pectus excavatum. Eur J Cardiothorac Surg, 2013, 43(2): 279-282.
- 41. Mao YZ, Tang S, Li S. Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: An updated meta-analysis. J Pediatr Surg, 2017, 52(10): 1545-1552.
- 42. Potaczek T, Duda S, Adamczyk J, et al. Comparison of postoperative period in patients with pectus excavatum treated with nuss technique and Ravitch technique. Ortop Traumatol Rehabil, 2015, 17(6): 577-686.
- 43. Papic JC, Finnell SM, Howenstein AM, et al. Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair. J Pediatr Surg, 2014, 49(6): 919-923.
- 44. Tikka T, Kalkat MS, Bishay E, et al. A 20-year review of pectus surgery: An analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg, 2016, 23(6): 908-913.
- 45. Brungardt JG, Chizek PW, Schropp KP. Adult pectus excavatum repair: national outcomes of the Nuss and Ravitch procedures. J Thorac Dis, 2021, 13(3): 1396-1402.
- 46. Toci GR, Davis TA, Bigelow BF, et al. Analyzing outcomes of Nuss and Ravitch repair for primary and recurrent pectus excavatum in adults. Ann Thorac Surg, 2020, 110(1): 272-275.
- 47. Jawitz OK, Raman V, Thibault D, et al. Complications after Ravitch versus Nuss repair of pectus excavatum: A Society of Thoracic Surgeons (STS) General Thoracic Surgery Database analysis. Surgery, 2021, 169(6): 1493-1499.
- 48. Harrison MR, Gonzales KD, Bratton BJ, et al. Magnetic mini-mover procedure for pectus excavatum Ⅲ: Safety and efficacy in a Food and Drug Administration-sponsored clinical trial. J Pediatr Surg, 2012, 47(1): 154-159.
- 49. Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg, 2005, 40(3): 496-500.
- 50. Rasihashemi SZ, Ramouz A. Pectus excavatum repair using Prolene polypropylene mesh. Asian Cardiovasc Thorac Ann, 2016, 24(2): 140-144.
- 51. Song IH, Lee SJ, Kim SS, et al. Surgical outcomes of double compression and complete fixation bar system in pectus excavatum. Ann Thorac Surg, 2018, 106(4): 1025-1031.
- 52. Kuyama H, Uemura S, Yoshida A. Chondrotomy and sternotomy combined with the Nuss procedure for severe asymmetric pectus excavatum: How to do it. Surg Today, 2021, 51(7): 1237-1240.
- 53. Li G, Jiang Z, Xiao H, et al. A novel modified Nuss procedure for pectus excavatum: a new steel bar. Ann Thorac Surg, 2015, 99(5): 1788-1792.
- 54. 吕方启, 吴茂军, 田茂良. 胸外悬吊固定治疗新生儿漏斗胸3例报告. 中国实用医药, 2008, 3(21): 160-161.
- 55. Wang W, Wang W, Long W, et al. Experience of the Wang procedure in treating pectus excavatum in two hundred fifty-six paediatric patients. Int Orthop, 2022, 46(10): 2307-2313.
- 56. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg, 2010, 252(6): 1072-1081.
- 57. Kelly RE, Mellins RB, Shamberger RC, et al. Multicenter study of pectus excavatum, final report: Complications, static/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg, 2013, 217(6): 1080-1089.
- 58. Gaspar Perez M, Nunez Garcia B, Alvarez Garcia N, et al. Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. Cir Pediatr, 2021, 34(4): 186-190.
- 59. Gałązka P, Leis K, Kroczek K, et al. Metal allergy after the Nuss procedure for pectus excavatum: A review. Postepy Dermatol Alergol, 2020, 37(6): 848-852.
- 60. Aneja S, Taylor JS, Soldes O, et al. Dermatitis in patients undergoing the Nuss procedure for correction of pectus excavatum. Contact Dermatitis, 2011, 65(6): 317-321.
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