Double-bar application decreases postoperative pain after the Nuss procedure Tomohisa Nagaso, MD, Junpei Miyamoto, MD, Kiyokazu Kokaji, MD, Ryohei Yozu,

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Presentation transcript:

Double-bar application decreases postoperative pain after the Nuss procedure Tomohisa Nagaso, MD, Junpei Miyamoto, MD, Kiyokazu Kokaji, MD, Ryohei Yozu, MD, Hua Jiang, MD, HongMei Jin, Tamotsu Tamaki, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 140, Issue 1, Pages 39-44.e2 (July 2010) DOI: 10.1016/j.jtcvs.2009.12.027 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Simulation of the correction bar insertion. The internal aspect of the sternum (Q) was elevated to reach the line connecting bilateral junctions of the costal cartilages and the ribs (P and R). The figures in the left and right columns indicate the thorax shapes before and after the operation, respectively. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 39-44.e2DOI: (10.1016/j.jtcvs.2009.12.027) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Differing stress-occurrence patterns of single-bar (left) and double-bar applications (right). With single-bar application, stress tends to concentrate on the fifth rib (arrow), whereas stresses are distributed widely across the thorax with double-bar application. V, the fifth rib. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 39-44.e2DOI: (10.1016/j.jtcvs.2009.12.027) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Left, Compressive force and torque work on the rib supporting the correction bar. Top right, In the single-strut support, intensified torque develops on the strut. Bottom right, In the double-strut support, torque doe snot develop on the struts. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 39-44.e2DOI: (10.1016/j.jtcvs.2009.12.027) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

On the basis of 3-dimensional computed tomographic data, a finite element model was produced for each patient. Figures in the left and right columns are the original computed tomographic data and the simulated model (viewed from different perspectives), respectively. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 39-44.e2DOI: (10.1016/j.jtcvs.2009.12.027) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

A representative result of the simulation: Figures in the left column are computed tomographic data of an actual double-bar application case. Figures in the right column show expected thorax shape, where the degree of correction for each part is demonstrated by color contour mapping. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 39-44.e2DOI: (10.1016/j.jtcvs.2009.12.027) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Rib -by-rib differences in stress-distribution patterns between single-bar and double-bar applications. The horizontal and vertical axes indicate the rib number and stresses occurring on the corresponding ribs. Asterisks indicate presence of significant differences. The bars inside the boxes indicate the averages of the data. Each box indicates the range in which 59% of the data are covered. The attaching bars indicate the whole data range. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 39-44.e2DOI: (10.1016/j.jtcvs.2009.12.027) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions