IMPROVEMENT OF TREATMENT TACTICS FOR SEVERE DEGREES OF PECTUS EXCAVATUM IN PRESCHOOL-AGED CHILDREN

Abstract

The pathogenesis of pectus excavatum involves not only osteochondral structures but also the soft tissue components of the anterior chest wall, including the sternodiaphragmatic ligament, which plays an important role. The aim of this study was to improve the treatment strategy for severe forms of pectus excavatum (PE) in preschool-aged children. Clinical material: the treatment outcomes of 30 children aged 1 to 6 years diagnosed with grade III–IV pectus excavatum were analyzed. Methods: the degree of deformity was determined using multislice computed tomography (MSCT). In all patients, the morphological and functional status of the sternodiaphragmatic ligament (SDL) was additionally assessed by ultrasonography (US). Based on these findings, an individualized treatment strategy was selected. In patients with grade III–IV deformities and the presence of contracture and fibrotic changes of the SDL, ligament release was performed followed by correction using the vacuum bell technique. Results: In preschool-aged children with severe pectus excavatum, assessment of the sternodiaphragmatic ligament using ultrasonography is of great importance for selecting the appropriate treatment strategy. In patients with a morphologically preserved ligament, vacuum bell therapy was effective, whereas in cases with fibrotic changes and contracture, the use of vacuum bell correction combined with ligament release provided significantly better clinical and anatomical outcomes. Statistical analysis of the obtained results demonstrated a significant association between anterior chest wall deformation and mechanical stresses and the severity of the deformity. According to MSCT and computational biomechanical modeling, both the compression depth and the maximum von Mises stress values increased in a statistically significant manner with increasing deformity severity (p < 0.01). Compared with patients with grade II deformity, those with grade III–IV deformities showed significantly higher compression depth values at the central anatomical points (P3–P5) (p < 0.01), while the differences at the peripheral points (P1–P2) were less pronounced (p < 0.05). This indicates that mechanical loading is predominantly concentrated in the central regions of the anterior chest wall. Conclusion: In the treatment of severe pectus excavatum in preschool-aged children, an individualized approach based on ultrasonographic evaluation of the sternodiaphragmatic ligament demonstrates high clinical efficacy, reduces the extent of invasive surgical interventions, and expands the possibilities for early correction.