Funnel chest is an inward and backward depression of the sternum and rib cage in a navicular or funnel shape; the deepest depression is at the junction of the sternal body and the sternal process. It has a familial tendency or is associated with congenital heart disease. It is thought that this deformity is due to uncoordinated rib growth, with the lower part of the rib cage growing more rapidly than the upper part, squeezing the sternum backward; it is also thought to be due to the frontal attachment of the diaphragm fibers to the body end of the sternum and the saber process, which pulls the sternum and saber process backward when the central tendon of the diaphragm is too short. The clinical manifestations of infantile funnel chest are often unnoticed in those with mild compressional symptoms. Some have inspiratory stridor and sternal aspiration depression, but the cause of the airway obstruction is often not detected. Children are often thin, immobile, prone to upper respiratory tract infections, and have limited mobility. Exertional expiratory volume and maximum ventilation volume are significantly reduced. The child may experience panic, shortness of breath and dyspnea during activity. In addition to thoracic deformity, physical signs often include mild hunchback, abdominal protrusion and other special body shapes. In addition to the thoracic deformity, there is a slight hunchback and protrusion of the abdomen, which can be seen on cardiac X-rays and cardiograms, and the heart is often displaced to the left and rotated in a clockwise direction. Treatment Some children with less obvious symptoms come to the clinic for psychological or cosmetic reasons. Except for those with mild deformities, they should be treated surgically. Early surgery is more effective, and surgical correction can be done after the age of 3-4 years. Surgical principles: ① cut off the attachment part of diaphragm with bone and saber, fully free the back of sternum and rib cartilage; ② cut off all sunken rib cartilage with the connection of rib bone and sternum, and wedge-shaped excision of a small section if too long; ③ transect the plane at the junction of sternal stem and sternal body, lift the sunken part, correct the whole thoracic deformity, and fix it properly (fixed with metal bracket or without bracket), called sternal rib lift surgery. In addition to the lift, there is another kind of sternal reversal (two kinds of sternal reversal without a tip and upper and lower sternal reversal with a vascular tip), that is, after the completion of step “①” according to the above-mentioned surgical principle, the rib cartilage and intercostal muscle are cut along the edge of the sunken rib cartilage from bottom to top, and then the sternum is transected to form a free sternal rib cartilage flap, which is reversed by 1800 After the flap is turned over, it is sutured back to the original location and fixed. In the former method, the arteries and veins of both sides of the thorax are ligated and cut off, and the attachment point of the rectus abdominis muscle is cut off to form a complete free; in the latter method, the sternum is turned over with the left and right thoracic arteries and veins and rectus abdominis muscle or only with the rectus abdominis muscle to form a cross, and then fixed appropriately. This method can maintain the normal blood flow of the sternum and ensure the normal development and growth of the sternum. At present, nuss minimally invasive surgery is often performed for funnel chest, which is less traumatic, faster recovery, less complications, and can meet the aesthetic requirements of patients. the whole procedure of NUSS method for funnel chest is simple to operate, and mainly consists of the following important steps: 1. first, the patient is under general anesthesia, and the monitor is turned on; then the lowest point of the sternal depression and both sides of the ribs of the patient are marked, and then iodine and alcohol are used to The entire thorax is disinfected. 2. Measure the length and shape of the patient’s thorax and select a suitable orthopedic plate. According to the patient’s thoracic shape, the orthopedic plate is slowly bent using plastic forceps until it is bent into the desired reverse U-shape. 3.A 2-5 cm long incision is made at the markings of the patient’s ribs on both sides to allow for the insertion of the funnel chest orthopedic plate and fixation plate. 4, Under thoracoscopic fluoroscopy, the traction separator is slowly and tentatively passed from one side of the incision through the lowest point of the patient’s sternal recess to the other side of the incision. Then, a guide wire is tied to the traction separator and returned along the original path to remove the traction separator. The guide wire is tied to the orthopedic plate and the plate is implanted in the body’s thoracic cavity in a U-shaped anterior path using the guide wire. The guide wire is untied and the orthopedic plate is slowly flipped into the desired reverse U-shape using a rotating handle. This process should be performed under the surveillance of the thoracoscope to avoid damage to the patient’s heart and other thoracic organs by traction separators and orthopedic plates. 5. A fixation plate is implanted in each side of the patient’s incision, the ends of the orthopedic plate are inserted into the slots of the plate, and the plate is sutured to the patient’s rib periosteum with surgical sutures. The two ends of the orthopedic plate and the fixation plate should be covered with muscle to avoid direct contact with the skin and compression of the skin. 6, During the surgery, attention should be paid to stopping bleeding as well as removing gas from the chest cavity and placing closed chest drains if necessary; if the orthopedic plate is fractured or deformed, the plate should be removed immediately. 7. Finally, the incisions on both sides of the patient are sutured smoothly with surgical sutures, and the surgery is over.