STUDY OF THE DISTRIBUTION OF STRESSES IN THE ELEMENTS OF THE STERNO-COSTAL COMPLEX AND METAL PLATES IN THE CASE OF MINIMALLY INVASIVE CORRECTION OF THE FUNNEL-SHAPED DEFORMATION OF THE CHEST ACCORDING TO NUSS
Keywords:Breast, deformation, correction, modeling
In severe forms, funnel-shaped chest deformity (FSCD) requires surgical correction. The method of choice is the Nuss operation and its modifications. Objective. To study the changes that occur in the stressed-deformed state of the chest model and the fixator under different methods of its implementation during the minimally invasive correction of FSCD according to Nuss. Material and methods. 4 schemes of FSCD correction were modeled: 1 — alignment with one retrosternal plate with transverse stabilizers, the point of entry and exit of the fixator is located parasternal at the level of the bone-cartilage transition, the fixator on the sides of the chest ends at the level of the front axillary line; 2 — sternal plate with transverse stabilizers, the point of entry and exit is located at the level of the front armpit line, the fixator ends at the level of the middle armpit line; 3 — the use of a double plate with transverse bars that connect the plates with the help of screws with medial conduction; 4 — a double plate with transverse slats, which connect the plates with the help of screws with lateral guidance. The models were loaded with a distributed force of 100 N applied to the sternum. The results. When using FSCD correction schemes, the maximum level of stress occurs in the metal plates, because they bear the main loads from the sternum, which tries to return to its original position after correction. The same reason causes the highest level of stress among the elements of the skeleton in the sternum. Conclusions. Under the conditions of using any FSCD correction scheme, the maximum stress level occurs in the metal plates, sternum, fifth and sixth ribs, which are in direct contact with the plates. The use of long plates with lateral points leads to a slight decrease in stress values in all elements of the model. The «Bridge» fastener allows you to significantly reduce the level of stress, both in the plates themselves and in the elements of the skeleton due to an increase in their contact area.
- Nuss, D., & Kelly, R. E. (2010). Indications and technique of Nuss procedure for Pectus Excavatum. Thoracic Surgery Clinics, 20 (4), 583–597. https://doi.org/10.1016/j.thorsurg.2010.07.002
- Jaroszewski, D. E., & Velazco, C. S. (2018). Minimally invasive Pectus Excavatum repair (MIRPE). Operative Techniques in Thoracic and Cardiovascular Surgery, 23 (4), 198–215. https://doi.org/10.1053/j.optechstcvs.2019.05.003
- Nuss, D., Kelly, R. E., Croitoru, D. P., & Katz, M. E. (1998). A 10-year review of a minimally invasive technique for the correction of pectus excavatum. Journal of Pediatric Surgery, 33 (4), 545–552. https://doi.org/10.1016/s0022-3468(98)90314-1
- Ben, X. S., Deng, C., Tian, D., Tang, J. M., Xie, L., Ye, X., Zhou, Z. H., Zhou, H. Y., Zhang, D. K., Shi, R. Q., Qiao, G. B., & Chen, G. (2020). Multiple-bar Nuss operation: An individualized treatment scheme for patients with significantly asymmetric pectus excavatum. Journal of Thoracic Disease, 12 (3), 949– 955. https://doi.org/10.21037/jtd.2019.12.43
- Radchenko, V., Popsuishapka, K., & Yaresko, O. (2017). Investigation of stress-strain state in spinal model for various methods of surgical treatment of thoracolumbar burst fractures (Рart one). ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 27–33. https://doi.org/10.15674/0030-59872017127-33
- Golovaha, M., Tyazhelov, A., Letuchaya, N., Subbota, I., & Karpinski, M. (2021). Biomechanical aspects of experimental study of functional treatment for S-shaped scoliosis. TRAUMA, 19 (1), 41–51. https://doi.org/10.22141/1608-1706.1.19.2018.126661
- Golovaha, M., Tiazhelov, O., Letuchaya, N., Subbota, I., & Karpinsky, M. (2021). Biomechanical aspects of experimental study of functional treatment of C-shaped scoliosis. TRAUMA, 20 (3), 32–41. https://doi.org/10.22141/1608-1706.3.20.2019.172091
- Schwend, R. M., Schmidt, J. A., Reigrut, J. L., Blakemore, L. C., & Akbarnia, B. A. (2015). Patterns of rib growth in the human child. Spine Deformity, 3 (4), 297–302. https://doi.org/10.1016/j.jspd.2015.01.007
- Li, Z., Kindig, M. W., Subit, D., & Kent, R. W. (2010). Influence of mesh density, cortical thickness and material properties on human rib fracture prediction. Medical Engineering & Physics, 32 (9), 998–1008. https://doi.org/10.1016/j.medengphy.2010.06.015
- Dworzak, J., Lamecker, H., Von Berg, J., Klinder, T., Lorenz, C., Kainmüller, D., Seim, H., Hege, H., & Zachow, S. (2009). 3D reconstruction of the human rib cage from 2D projection images using a statistical shape model. International Journal of Computer Assisted Radiology and Surgery, 5 (2), 111–124.
- Mohr, M., Abrams, E., Engel, C., Long, W. B., & Bottlang, M. (2007). Geometry of human ribs pertinent to orthopedic chest-wall reconstruction. Journal of Biomechanics, 40 (6), 1310– 1317. https://doi.org/10.1016/j.jbiomech.2006.05.017
- Awrejcewicz J., & Luczak B. (2006). Dynamics of human thorax with Lorenz pectus bar. Proceeding XXII symposium «Vibrations in physical systems». PoznanBеdlewo.
- Yoganandan, N., Kumaresan, S., Voo, L., Pintar, F., & Larson, S. (1996). Finite element modeling of the C4–C6 cervical spine unit. Medical Engineering & Physics, 18 (7), 569–574. https://doi.org/10.1016/1350-4533(96)00013-6
- Knets I.V., & Pfafrod G.O. (1980) Saulgozis Yu.Zh. Deformation and destruction of solid biological tissues. Riga: Zinatne.
- Berezovsky V.A., & Kolotilov N.N. (1990) Biophysical characteristics of human tissues. Directory. Kyiv: Naukova Duma.
- Alyamovsky A. A. (2004). SolidWorks/COSMOSWorks. Engineering analysis using the finite element method. Moscow:
- DMK Press. 17. Zienkiewicz, O. C., Taylor, R. L., & Zhu, J. (2005). The finite element method: Its basis and fundamentals. Butterworth-Heinemann.
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