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

Abstract

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.

Keywords

children / pectus excavatum / body mass index / minimally invasive surgery / thoracoplasty / postural balance

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Funding

Government of the Russian FederationПравительство РФ(1023021600029-8-3.2.10)