A Novel in Silico Nuss Procedure for Pectus Excavatum Patients

Overview

Journal Phys Eng Sci Med

Publisher Springer

Specialty Biomedical Engineering

Date 2023 Sep 11

PMID 37695510

Authors

Beop-Yong Lim

Dongman Ryu

Hoseok I

Chiseung Lee

Affiliations

Soon will be listed here.

Abstract

The purpose of this study is to suggest a novel in silico Nuss procedure that can predict the results of chest wall deformity correction. Three-dimensional (3D) geometric and finite element model of the chest wall were built from the 15-year-old male adolescent patient's computed tomography (CT) image with pectus excavatum of the mild deformity. A simulation of anterior translating the metal bar (T) and a simulation of maintaining equilibrium after 180-degree rotation (RE) were performed respectively. A RE simulation using the chest wall finite element model with intercostal muscles (REM) was also performed. Finally, the quantitative results of each in silico Nuss procedure were compared with those of postoperative patient. Furthermore, various mechanical indicators were compared between simulations. This confirmed that the REM simulation results were most similar to the actual patient's results. Through two clinical indicators that can be compared with postoperative patient and mechanical indicators, the authors consider that the REM of silico Nuss procedure proposed in this study is best simulated the actual surgery.

Citing Articles

Biomechanical Effectivity Evaluation of Single- and Double-Metal-Bar Methods with Rotation and Equilibrium Displacements in Nuss Procedure Simulations.

Lim B, I H, Lee C Ann Biomed Eng. 2024; 52(4):1067-1077.

PMID: 38302767 DOI: 10.1007/s10439-024-03441-z.

Biomechanical validation of novel Nuss procedure simulations for patients with various morphological types of pectus excavatum.

Lim B, I H, Lee C Front Bioeng Biotechnol. 2023; 11:1297420.

PMID: 38026863 PMC: 10667684. DOI: 10.3389/fbioe.2023.1297420.

References

Nagaso T, Miyamoto J, Kokaji K, Yozu R, Jiang H, Jin H . Double-bar application decreases postoperative pain after the Nuss procedure. J Thorac Cardiovasc Surg. 2010; 140(1):39-44, 44.e1-2. DOI: 10.1016/j.jtcvs.2009.12.027. View

Nuss D, Kelly Jr R . Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin. 2010; 20(4):583-97. DOI: 10.1016/j.thorsurg.2010.07.002. View

Wang T, Cai Z, Zhao Y, Zheng G, Wang W, Qi D . Development of a Three-Dimensional Finite Element Model of Thoracolumbar Kyphotic Deformity following Vertebral Column Decancellation. Appl Bionics Biomech. 2019; 2019:5109285. PMC: 6545817. DOI: 10.1155/2019/5109285. View

Ye J, Lu G, Feng J, Zhong W . Effect on Chest Deformation of Simultaneous Correction of Pectus Excavatum with Scoliosis. J Healthc Eng. 2017; 2017:8318694. PMC: 5613367. DOI: 10.1155/2017/8318694. View

Yoshida R, Tomita K, Kawamura K, Nozaki T, Setaka Y, Monma M . Measurement of intercostal muscle thickness with ultrasound imaging during maximal breathing. J Phys Ther Sci. 2019; 31(4):340-343. PMC: 6451941. DOI: 10.1589/jpts.31.340. View

Goretsky M, Kelly Jr R, Croitoru D, Nuss D . Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin. 2005; 15(3):455-71. DOI: 10.1016/j.admecli.2004.06.002. View

Ghionzoli M, Ciuti G, Ricotti L, Tocchioni F, Lo Piccolo R, Menciassi A . Is a shorter bar an effective solution to avoid bar dislocation in a Nuss procedure?. Ann Thorac Surg. 2014; 97(3):1022-7. DOI: 10.1016/j.athoracsur.2013.11.037. View

Park H, Lee S, Lee C, Youm W, Lee K . The Nuss procedure for pectus excavatum: evolution of techniques and early results on 322 patients. Ann Thorac Surg. 2004; 77(1):289-95. DOI: 10.1016/s0003-4975(03)01330-4. View

Pilegaard H . Short Nuss bar procedure. Ann Cardiothorac Surg. 2016; 5(5):513-518. PMC: 5056936. DOI: 10.21037/acs.2016.09.06. View

10.

Chang P, Hsu Z, Chen D, Lai J, Wang C . Preliminary analysis of the forces on the thoracic cage of patients with pectus excavatum after the Nuss procedure. Clin Biomech (Bristol). 2008; 23(7):881-5. DOI: 10.1016/j.clinbiomech.2008.02.010. View

11.

Xie L, Cai S, Xie L, Chen G, Zhou H . Development of a computer-aided design and finite-element analysis combined method for customized Nuss bar in pectus excavatum surgery. Sci Rep. 2017; 7(1):3543. PMC: 5471251. DOI: 10.1038/s41598-017-03622-y. View

12.

Burrowes K, Clark A, Marcinkowski A, Wilsher M, Milne D, Tawhai M . Pulmonary embolism: predicting disease severity. Philos Trans A Math Phys Eng Sci. 2011; 369(1954):4255-77. DOI: 10.1098/rsta.2011.0129. View

13.

Lim B, Kim Y, I H, Lee C . Numerical investigation of the sternoclavicular joint modeling technique for improving the surgical treatment of pectus excavatum. Sci Rep. 2020; 10(1):7357. PMC: 7192908. DOI: 10.1038/s41598-020-64482-7. View

14.

Daunt S, Cohen J, Miller S . Age-related normal ranges for the Haller index in children. Pediatr Radiol. 2004; 34(4):326-30. DOI: 10.1007/s00247-003-1116-1. View

15.

Nan J, Rezaei M, Mazhar R, Jaber F, Musharavati F, Zalnezhad E . Finite Element Analysis of the Mechanism of Traumatic Aortic Rupture (TAR). Comput Math Methods Med. 2020; 2020:6718495. PMC: 7364233. DOI: 10.1155/2020/6718495. View

16.

Moon D, Park C, Moon M, Park H, Lee S . The effectiveness of double-bar correction for pectus excavatum: A comparison between the parallel bar and cross-bar techniques. PLoS One. 2020; 15(9):e0238539. PMC: 7498055. DOI: 10.1371/journal.pone.0238539. View

17.

Nuss D, Kelly Jr R, Croitoru D, Katz M . A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998; 33(4):545-52. DOI: 10.1016/s0022-3468(98)90314-1. View