Biomechanical modeling and problematic issues of surgical correction of congenital funnel chest deformity

Abstract

Congenital funnel chest deformity (CFCD) is noted in 0.6–2.3% of the population and accounts for 90% of all congenital chest deformities. Nuss thoracoplasty is the most common method for treating CFCD, which is considered a minimally invasive technology and provides a quick cosmetic effect. Purpose is to search for models of CFCD and its surgical correction in order to create a technique that is as close to reality as possible, which will make it possible to optimally plan and rationally carry out the forthcoming operation. Analysis of literature sources showed that, on the one hand, the construction of simplified models of the chest allows quick research, but these simplifications do not allow for an objective assessment of the influence and interaction of various elements of the complex biomechanical system «sternum–rib–spine». On the other hand, complex models are more reliable, but hardly available for implementation due to their ultra-high manufacturability and cost. In addition, in studies of stress-strain state on models of the chest, the presence of the spinal column or the interaction of the ribs with the vertebrae has been insufficiently studied. When in the works on modeling road traffic injuries this is justified due to the support of the spine on the seat, then when modeling the correction of chest deformities, the lack of consideration of the mobility of the articular joints and the flexibility of the spinal column can lead to incorrect and false results. It is promising to create a technique for modeling CFCD and its surgical correction in conditions close to reality. This will make it possible to develop a rational modification of thoracoplasty based on the D. Nuss operation under the condition of one–stage full–fledged stable correction and minimal biomechanical loads in the «sternum-rib-spine» system. No conflicts of interest was declared by the authors. Key words: funnel chest deformity, thoracoplasty, biomechanics.