Features of vertical body balance in children with asymmetric pectus excavatum before and after surgical correction

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BACKGROUND: Currently, minimally invasive repair of pectus excavatum are being developed. However, studies on the physiological aspects of the patient’s body in response to surgery are limited. Recently, researchers have become interested in the functional diagnosis of the state of the musculoskeletal system in patients with this pathology.

AIM: To assess the dynamics of vertical body balance in patients with severe right-sided pectus excavatum before and after minimally invasive reconstructive operations aimed at eliminating deformity.

MATERIALS AND METHODS: Clinical radiation and stabilometric studies of 22 patients aged 13–16 years with right-sided pectus excavatum were conducted. Group A included patients with a low body mass index of 16.0 (15.3–17.7) kg/m2. Group B consisted of ten patients with normal body mass index values of 18.5 (17.7–20.4) kg/m2. In patients of both groups, an analysis of the stabilometric parameters of the movement of the general body pressure center and individually the pressure centers of the left and right lower extremities was performed before surgery and 1.5–2 years after. The patients underwent the same type of bone reconstructive surgery that is, minimally invasive repair of pectus excavatum. The stabilometric parameters of the patients were compared with similar parameters of 20 healthy children in the control group.

RESULTS: In both groups of patients, a deterioration in vertical balance was recorded before surgery compared with healthy children. In group A, a relatively stable balance of the total body pressure center was revealed, with a deterioration in the movement parameters of the pressure centers of the left and right lower extremities. In contrast, in group B, the mechanism for ensuring a vertical stance was the opposite: a less stable balance of the general center of body pressure against the background of greater postural stability of the contralateral lower extremities was observed. This indicates heterogeneous locomotor strategies to ensure vertical balance in patients with different body mass indices. In the long term, to correct chest deformity after surgery, the patients of both groups showed opposite changes in the postural control system. In patients with a low body mass index, further deterioration was noted in vertical balance; the quality of balance function decreased from 78% to 69% (p < 0.05). Moreover, patients with normal body mass index showed an improvement in posture stability; the quality of balance function increased from 74% to 83% (p < 0.05).

CONCLUSIONS: In patients with pectus excavatum with reduced body mass index, it is recommended to conduct an individual rehabilitation program after minimally invasive deformation correction to adapt them postoperatively and normalize the vertical balance of the body.

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作者简介

Igor Nikityuk

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: femtotech@mail.ru
ORCID iD: 0000-0001-5546-2729
SPIN 代码: 5901-2048

MD, PhD, Cand. Sci. (Medicine)
俄罗斯联邦, Saint Petersburg

Yuriy Garkavenko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: yurijgarkavenko@mail.ru
ORCID iD: 0000-0001-9661-8718
SPIN 代码: 7546-3080

MD, PhD, Dr. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Dmitry Ryzhikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dryjikov@yahoo.com
ORCID iD: 0000-0002-7824-7412
SPIN 代码: 7983-4270

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Bahauddin Dolgiev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dr-b@bk.ru.Bahauddin
ORCID iD: 0000-0003-2184-5304
SPIN 代码: 2348-4418

MD

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Appearance of the chest and multislice spiral computed tomography scans of patients with severe right-sided pectus excavatum before surgery: a, a 15-year-old male patient (Group A, body mass index 17.6 kg/m2), Haller index = 6.82; b, a 15-year-old male patient (Group B, body mass index 18.9 kg/m2), Haller index = 5.4.

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3. Fig. 2. Appearance of the chest and multislice spiral computed tomography scan of a 14-year-old male patient (Group A, body mass index 15.6 kg/m2) with severe right-sided pectus excavatum: a, before surgery (Haller index = 3.8); b, at 1.5 years post-surgery (Haller index = 1.98).

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4. Fig. 3. Appearance the chest and multislice spiral computed tomography scan of a 14-year-old female patient (Group B, body mass index 19.5 kg/m2) with severe right-sided pectus excavatum: a, before surgery (Haller index = 5.05); b, at 2 years post-surgery (Haller index = 1.74).

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5. Fig. 4. Graphic image of the movements of the general center of pressure (COP), the centers of pressure of the left (COPL) and right (COPR) lower extremities of the assessed pediatric patients: a, median angles ao of the general center of pressure (red line) and median coordinates of the centers of pressure of the contralateral lower extremities measured in healthy children; b, statokinesiograms of a patient with right-sided pectus excavatum. al and ar, oscillation angles of the COPL and COPR; Sl, So, and Sr, statokinesiogram areas.

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6. Fig. 5. Median angles ao of the general center of pressure (COP) (red line) and median coordinates of the centers of pressure of the left (COPL) and right (COPR) lower extremities of patients with right-sided pectus excavatum before surgery: a, Group A (body mass index <18 kg/m2); b, Group B (body mass index >18 kg/m2).

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7. Fig. 6. Median angles ao of the general center of pressure (COP) (red line) and median coordinates of the centers of pressure of the left (COPL) and right (COPR) lower extremities of patients with right-sided pectus excavatum after surgery: a, Group A (body mass index <18 kg/m2); b, Group B (body mass index >18 kg/m2).

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8. Fig. 7. Movement of the centers of pressure of the left and right lower extremities of patients with severe right-sided pectus excavatum at 2 years post-surgery (top down: statokinesiograms; preference zones; velocity vector clouds): a, a 16-year-old male patient (Group A, body mass index 15.4 kg/m2), Haller index = 2.02, integral movement asymmetry 4.09 mm × deg/s2; b, a 16-year-old male patient (Group B, body mass index 19.7 kg/m2), Haller index = 2.07, integral movement asymmetry 0.51 mm × deg/s2). In the patient from group B with a normal body mass index, the asymmetry of the stabilometric variables between the contralateral lower extremities was insignificant.

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