The sternum bulges forward and is called pectus carinatum (chicken breast), which is a common thoracic deformity, generally considered to be related to genetics as well as the funnel chest deformity, and most people believe that it is caused by the overgrowth of ribs and rib cartilage, accounting for about 6% to 22% of the chest deformity, male:female is about 3:1. The incidence of the disease ranks after funnel chest. It is the second most common chest wall deformity after funnel chest.
Etiology
Most people believe that the deformity of the sternum is secondary to the deformity of the ribs and rib cartilage.
Clinical symptoms
The incidence of pectus excavatum is lower than that of funnel chest and the clinical symptoms are milder, so it is less appreciated by patients and their families. The lateral X-ray chest film can clearly show the deformity of the sternum, but other examination methods often have no abnormal findings.
Clinically, according to the different morphology of the sternum, there are three types of corpus cavernosum.
1.Ship-shaped chest
Mainly for the sternum elongation, forward projection, bilateral lower part of the rib cartilage sagging, like the keel of a boat, serious cases to reduce the volume of the chest cavity. On the lateral X-ray, the ribs are separated from the sternum, and the posterior sternal space is prolonged.
2.Spherical pigeon chest
Spherical pigeon chest is characterized by the elevation of the sternal stalk, sternal body joint and adjacent rib cartilage, if there is a reduction of the sternal angle, it will cause the sinking of the lower 2/3 of the sternal body, so that the 2nd to 5th rib cartilage is elevated next to the sternum.
3.Unilateral pectus excavatum
Unilateral pectus excavatum, also known as asymmetric pectus excavatum, is characterized by protrusion of one side of the chest wall, sometimes accompanied by subsidence of the opposite side. The rib cartilage deformity plays an important role in this type, and the abnormal position of the sternum is not obvious.
Auxiliary examination
(1) X-ray: chest X-ray shows obvious sagging of the lower part of the sternum and adjacent rib cartilage, and increased spacing between the spine and sternum. Spinal X-ray observes whether there is scoliosis of the spine, etc.
(2) CT scan: Using CT scan can more accurately evaluate the degree of protrusion, symmetry, cardiac and pulmonary impact and combination of other problems in cocksucker’s chest. For example, combined with cystic adenomatoid malformation of the lung, isolated lung, diaphragm expansion, etc.
(3) Electrocardiogram: occasional sinus arrhythmia and incomplete right bundle branch block.
(4) Cardiac ultrasound; useful for detecting combined congenital heart disease.
(5) Cardiac and pulmonary function tests: in very severe cases, cardiopulmonary function is decreased.
(6) Blood biochemistry: some patients have mild anemia and increased serum alkaline phosphatase.
Treatment measures
I. Moderate to severe corpus cavernosum
Surgery is recommended.
1.Traditional surgery
(1)Upper and lower sternal reversal with vascularized tip.
(2)Sternal reversal without a tip.
(3)Thoracic rib countersinking surgery. Relatively more used. The anterior median or transverse incision is made to separate both sides of the pectoralis major muscle, reveal the deformed pectoralis muscle and both sides of the rib cartilage, cut the rectus abdominis muscle at the attachment point of the rectus abdominis muscle, turn it downward, cut the periosteum of the ribs, excise the overlong part of each rib cartilage involved in the scope of deformity, and suture the overlong periosteum longitudinally, if the deformity of the pectoralis muscle is serious also need to make a transverse wedge osteotomy to flatten the sternum, then fix it with a wire, pull together and suture the pectoralis major muscle The pectoralis major muscle is then pulled together and sutured to the front of the sternum. The result of the surgery is very satisfactory.
2.Minimally invasive surgery
That is, NUSS surgery for chicken breast. The principle is similar to the minimally invasive funnel chest correction. Only one is to pass the steel plate from behind the sternum and then flip up the sternum, and the other is to press the shaped steel plate down on the uplifted sternum and fix it with the ribs to achieve the purpose of orthopedics. Our hospital has carried out this kind of minimally invasive surgery earlier in Yunnan province, which is worth promoting because of the less damage and excellent effect compared with traditional surgery. We also welcome patients to come for consultation.
Mild corpus cavernosum
It is a common phenomenon for children to have mild chicken breast, because during the rapid development period, children have a greater demand for various nutrients. When daylight hours are short and vitamin D or calcium intake is insufficient, chicken chest and rib exostosis will occur.
Mild corpus cavernosum does not need to be corrected. Let your child be active in the sunshine, take some calcium supplements or drink more milk, eat more shrimp and other foods with high calcium content in general. What is more important is to let the child do moderate physical training, teach the child to do arm spreading and chest expansion every day, and go to the fresh air to do deep breathing. Through a period of correction, the child’s chicken chest is likely to be improved and corrected.
Preventive measures
1.Mothers should pay attention to nutrition at the end of pregnancy, eat more eggs, animal liver and other foods containing vitamin D and protein, get sunlight frequently, and take vitamin D and calcium supplements under the guidance of doctors.
2, newborn babies should be breastfed as far as possible, because breast milk vitamin D and other nutrients are easily absorbed. 4 months old baby began to add supplementary food, do not cereal-based food, otherwise it will affect the absorption of calcium salts in the diet. You should gradually add eggs, liver and other foods that contain more vitamin D.
3, sunshine is the most convenient and economic, safe and effective way to prevent rickets. After a full month, small infants can gradually increase the sunlight time. In normal weather, sunlight for about 2 hours a day.
4. Take vitamin D and calcium supplements under the guidance of a doctor and go to health care units for regular health checkups.
Complications
In patients with this disease, lighter chickens may have no complications or no clinical symptoms, while severe cases may have corresponding clinical symptoms due to the deformed sternum that changes the thorax and squeezes the heart and lungs, causing the heart and lung functions to be seriously affected, and are mostly accompanied by comorbidities. For example, Marfan syndrome and neurofibromatosis are combined, and respiratory complications such as recurrent upper respiratory tract infections and bronchial wheezing are often seen in patients with severe chicken breasts.