title: Costochondral changes in the chest wall after the Nuss procedure: ultrasonographic findings.
abstract: OBJECTIVE
  The Nuss procedure is one of the most popular surgeries for correcting pectus excavatum. However, little is known regarding stress and strain on the deformed ribs after inserting the pectus bar. We used ultrasonography to investigate costochondral changes before and after the Nuss procedure.
  
  
  METHODS
  Ninety-five patients underwent the Nuss procedure between July 2007 and February 2008 at 2 institutions. Chest ultrasonography, specifically of the bones and cartilage, was performed 1 day before and 1 week after the operation.
  
  
  RESULTS
  Postoperatively, all patients showed various degrees of deformation from the second to sixth cartilages bilaterally. The cartilages were not fractured. Of these patients, 28 (29.5%) had significant changes, including acute angulation of the costochondral junction and rib fractures near the pectus bar. These changes were associated with increased age (P < .01) and the degree of postoperative sternum elevation (P < .01). The pectus index and sex were not significant predictors of rib damage.
  
  
  CONCLUSIONS
  The Nuss procedure created significant stress and strain over the deformed cartilages. Approximately 29% of the patients showed localized, self-limited costochondral changes via chest ultrasonography.
authors.affiliation: Department of Thoracic Surgery, Beijing Children Hospital Affiliated to Capital Medical University, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zeng
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
authors.forename: Xiao-Man
authors.initials: XM
authors.lastname: Wang
authors.forename: Jhon-Liau
authors.initials: JL
authors.lastname: Lee
authors.forename: Shu-Ti
authors.initials: ST
authors.lastname: Chia
authors.forename: Chao-Jan
authors.initials: CJ
authors.lastname: Wang
authors.forename: Jeng-Chang
authors.initials: JC
authors.lastname: Chen
authors.forename: Pei-Yeh
authors.initials: PY
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D002356:Cartilage / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019919:Prosthesis Implantation; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D013249:Sternum / Q000601:surgery*; D013314:Stress, Mechanical; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000601:surgery*; D013905:Thoracoplasty / Q000009:adverse effects* / Q000379:methods; D014463:Ultrasonography; D055815:Young Adult