Pectus excavatum (PE) is a common congenital chest malformation in children, manifested by inward depression of the anteriorthorax wall, which can compress the normal tissues and organs in the chest and cause adverse effects on the physiology and psychology of patients. Surgery is the most important means of treating PE, and with the invention of Nuss surgery, the surgical treatment of PE has entered the minimally invasive era. At present, there are many indexes to evaluate the severity of thoracic malformations in PE patients, and selecting appropriate evaluation indexes is of great significance for the formulation of surgical protocols. As a physical and mental disease, PE's deformed thoracic appearance not only affects the function of thoracic organs, but also affects the psychological state of patients. Therefore, there is still controversy over whether the role of orthopedic surgery is to improve function or cosmetic plastic surgery. At the same time, the orthopedic efficacy and postoperative complications of the existing modified and novel surgical methods need to be further observed and evaluated. In addition, the design of surgical plan and the selection of surgical timing for PE combined with other diseases are also critical and controversial issues in clinical practice. Therefore, this article explores and reviews the controversial points in the current surgical treatment of PE.
Objective To investigate the efficacy and safety of an ultra-minimally invasive incision technique in the Nuss procedure for the correction of pectus excavatum. Methods We retrospectively analyzed the clinical data of patients with pectus excavatum who underwent the Nuss procedure at Tangdu Hospital, Air Force Medical University, from September 2019 to September 2024. Patients were divided into two cohorts: an ultra-minimally invasive incision group and a conventional incision group. Baseline characteristics, efficacy outcomes (e.g., postoperative Haller index), and safety outcomes (e.g., operative time, intraoperative blood loss, postoperative length of stay, and complications) were collected and compared between the two groups. Results A total of 125 patients were included. The ultra-minimally invasive incision group consisted of 49 patients (43 male, 6 female) with a median age of 14 (12.5, 16) years, while the conventional incision group included 76 patients (64 male, 12 female) with a median age of 14 (12, 16) years. Compared to the conventional group, the ultra-minimally invasive incision group had significantly less intraoperative blood loss [10 (5, 20) mL vs. 20 (10, 30) mL, P=0.012], a shorter postoperative length of stay [4 (3, 4) d vs. 4 (3, 5) d, P=0.014], a lower incidence of postoperative incision complications [2.04% (1/49) vs. 14.47% (11/76), P=0.027], and a lower visual analogue scale (VAS) score on postoperative day 1 [(3.68±0.62) points vs. (5.37±0.89) points, P<0.001]. There were no statistically significant differences between the two groups in operative time, postoperative Haller index, or the incidence of other complications such as pleural effusion and pneumothorax (all P>0.05). Conclusion The ultra-minimally invasive incision technique can significantly reduce the incidence of incision-related complications and alleviate early postoperative pain in patients undergoing the Nuss procedure. It is a safe and feasible surgical approach for the correction of pectus excavatum.
ObjectivesTo evaluate the methodological quality of guidelines for pharmacological intervention of migraine in adults, to compare and analyze the differences in first-line drug recommendations in different regions and quality levels, so as to explore the evidence of drug recommendations, and provide a basis for clinical decision-making.MethodsPubMed, The Cochrane Library, EMbase, SinoMed, CNKI, VIP, and WanFang Data databases, Up To Date, as well as the related books, Yimaitong, Guideline Central, Guidelines International Network (GIN) and National Institute for Health and Clinical Excellence (NICE) were systematically searched to collect pharmacological intervention guidelines of migraine in adults from inception to January 12th, 2020. The methodological quality of the guidelines was evaluated by Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ).ResultsA total of 25 guidelines were included (including 22 evidence-based guidelines), covering 10 countries on 4 continents and World Health Organization (WHO) with a time span of 1997 to 2019. According to AGREE Ⅱ, 5 were A-level guidelines, 18 were B-level guidelines, and 2 were C-level guidelines. Scope and purpose, rigour of development, clarity of presentations and editorial independence obtained high average scores (more than 60%) among all 25 guidelines. The average scores of guidelines in different domains of AGREE Ⅱ varied with regions and countries. Triptans and NSAIDs were the most frequently recommended as first-line drugs for the acute management; beta-blockers and antiepileptic drugs were recommended for the first-line prevention drugs of migraine in adults. There were 2 guidelines that recommended complementary treatments, one recommended traditional Chinese medicine and another recommended herbal butterbur.ConclusionsThe methodological quality of the pharmacological intervention guidelines of migraine in adults is suboptimal among different regions or countries. The quality of evidence-based guidelines is superior to that established by consensus. The consistency of first-line drug recommendations is strong, but there are still regional differences. The therapeutic effect of traditional Chinese medicine requires further verification.