Deformations of a thorax at children – congenital or early the acquired curvature of a breast and the edges which are jointed with it. Deformations of a thorax at children are shown by visible cosmetic defect, violations from aspect of activity of respiratory and cardiovascular systems (short wind, frequent respiratory diseases, bystry fatigue). Diagnostics of deformation of a thorax at children assumes carrying out a torakometriya, X-ray analysis (KT, MPT) of bodies of a thorax, backbone, breast, edges; functional researches (FVD, EhoKG, ECG). Children can have a conservative treatment of deformation of a thorax (LFK, massage, carrying an external corset) or surgical.
Deformations of a thorax at children
Deformations of a thorax at children – the pathological change of a form, volume, thorax sizes leading to reduction of grudino-vertebral distance and violation of position of internals. Deformations of a thorax occur at 14% of the population; at the same time (mainly at boys) congenital anomalies are diagnosed for children with a frequency of 0,6-2,3%. Deformations of a thorax at children represent cosmetic defect, can cause functional problems from breath and warm activity, cause psychological discomfort to the child. These circumstances adversely affect harmonious development of children and their social adaptation. The problem of deformations of a thorax at children is urgent for thoracic surgery, children's traumatology and orthopedics, children's cardiology, children's psychology.
The reasons of deformations of a thorax at children
On time of development and the influencing causal factors distinguish the congenital and acquired deformations of a thorax at children. Congenital deformations can be caused by the genetic reasons or result from violation of development of a skeleton (a breast, edges, a backbone, shovels) in the pre-natal period.
Hereditary deformations of a thorax in certain families arise at children in 20-65% of cases. Now the set of syndromes is known, to one of components of which serve defects of a grudino-costal complex. The most widespread among them is Marfan's syndrome which is characterized by an asthenic constitution, arakhnodaktiliy, funneled and keeled deformation of a thorax, stratified aorta aneurism, an incomplete dislocation and dislocation of crystalline lenses, biochemical changes of exchange of glikozaminoglikan and collagen. At children the dysplasia of cartilaginous and connecting tissue developing as a result of different enzymatic violations is the cornerstone of formation of hereditary deformations of a thorax.
The causes not hereditary (sporadic forms) defects of a forward chest wall are unknown. Can lead any teratogenny factors operating on the developing fruit to it. The most often congenital deformations of a thorax at children are caused by the uneven growth of a breast and costal cartilages, diaphragm pathology (short muscle fibers can pull in a breast inside), pathology of development of cartilages and connecting fabric.
The acquired deformations of a thorax at children, as a rule, develop as a result of the postponed diseases of bone and muscular system – rickets, tuberculosis, scoliosis, system diseases, tumors of edges (hondry, ostey, ekzostoz), osteomyelitis of edges, etc. In some cases the acquired deformation of a thorax is caused by pyoinflammatory diseases of soft fabrics of a chest wall (phlegmon) and pleurae (chronic empiyemy), sredosteniye tumors (teratomy, a neurofibromatosis, etc.), injuries and burns of a thorax, emphysema of lungs. Besides, deformations of a thorax at children can be a consequence of unsatisfactory results of a torakoplastika, median sternotomiya concerning congenital heart diseases.
Classification of deformations of a thorax at children
By the form children can have symmetric deformations of a thorax and asymmetric (right-hand, left-side). Among congenital deformations of a thorax at children in pediatrics the funneled breast (pectus excavatum) and a keeled breast (pectus carinatum) meet more often. Poland's syndrome, a breast crevice, etc. belong to rare congenital deformations of a thorax (about 2%).
Funneled deformation of a thorax at children ("the shoemaker's breast") makes about 85-90% of congenital malformations of a chest wall. Is its characteristic sign various in a form and depth zapadeny breasts and forward departments of edges, followed by reduction of volume of a chest cavity, shift and rotation of heart, a backbone curvature.
Expressiveness of funneled deformation of a thorax at children can carry 3 degrees:
- I – vdavleny breasts to 2 cm; heart is not displaced;
- II – vdavleny breasts of 2-4 cm; shift of heart is less than 3 cm;
- III – vdavleny breasts more than 4 cm; shift of heart is more than 3 cm.
Keeled deformation of a thorax ("pigeon", "chicken" breast) occurs at children less than funneled; at the same time 3 of 4 cases of anomaly fall on boys. At a keeled thorax of an edge join a breast at right angle, "pushing out" it forward, increasing the front-back size of a thorax and giving it the form of Kiel.
Extents of keeled deformation of a thorax at children include:
- I – protrusion of a breast to 2 cm over the normal surface of a thorax;
- II – protrusion of a breast from 2nd to 4 cm;
- III – protrusion of a breast from 4th to 6 cm.
The acquired deformation of a thorax at children is subdivided on kifoskoliotichesky, emphysematous, boatshaped and paralytic.
Symptoms of deformations of a thorax at children
Clinical manifestations of funneled deformation of a thorax differ depending on age of the child. At babies the vdavleniye of a breast is usually hardly noticeable, however "the breath paradox" is noted - the breast and edges sink down at a breath, at shout and crying of the child. At children of younger age the funnel becomes more noticeable; tendency to frequent respiratory infections (tracheitises, bronchitis, recurrent pneumonia), bystry fatigue in games with peers is noted.
Funneled deformation of a thorax reaches the greatest expressiveness at children of school age. At survey the flattened thorax decides on raised edges of edges, the lowered , a protruding stomach, chest , side curvatures of a backbone. "The breath paradox" is swept up at deep breath. Children with funneled deformation of a thorax have the lowered body weight, pale integuments. Low physical endurance, short wind, perspiration, tachycardia, pain in heart, arterial hypertension are characteristic. Owing to frequent bronchitis at children the bronkhoektatichesky disease quite often develops.
Keeled deformation of a thorax at children usually is not followed by serious functional violations therefore as the main display of pathology serves cosmetic defect - protrusion of a breast forward. Extent of deformation of a thorax at children can progress with age. At change of situation and shape of heart can take place of the complaint to bystry fatigue, heartbeat and short wind.
Children school students with deformation of a thorax osoyoznat the physical defect, try to hide it that can lead to secondary mental stratifications and demand the help from the children's psychologist.
Poland's syndrome or costal and muscular defect includes a complex of defects among which there is a lack of pectoral muscles, a brakhidaktiliya, a sindaktiliya, an amastiya or an ateliya, deformation of edges, lack of axillary pilosis, reduction of a hypodermic and fatty layer.
The crevice of a breast is characterized its partial (in the field of the handle, a body, a xiphoidal shoot) or total splitting; at the same time a pericardium and the intaktna skin covering a breast.
Diagnostics of deformations of a thorax at children
Fizikalny inspection of the child by the pediatrician allows to reveal visible change of a form, the sizes, symmetry of a thorax; to find functional noise in heart, tachycardia, rattles in lungs etc. Quite often at survey of children with deformation of a thorax various dizembriogenetichesky stigmata come to light: hyper mobility of joints, , Gothic sky, etc. Existence of objective signs of deformation of a thorax demands profound tool inspection of children under the leadership of the thoracic surgeon or the children's traumatologist-orthopedist.
Degree and the nature of deformation of a thorax at children decides on the help of the torakometriya giving an idea of depth and width of the thorax, its slanting sizes, a thoracic index and also allowing to track these indicators in dynamics. More exact data receive after carrying out a X-ray analysis and KT of a thorax, a breast, edges, a backbone. These researches allow to estimate bone structure of a thorax, change in lungs, degree of shift of bodies of a sredosteniye.
For definition of weight of secondary changes from warm and pulmonary system the electrocardiography, EhoKG, heart MRT, spirometry, consultations of the children's pulmonologist and children's cardiologist is carried out.
Treatment of deformations of a thorax at children
Treatment of keeled deformation of a thorax at children is begun with conservative actions: carrying out LFK, massage, medical swimming, carrying special compression systems and children's orthoses. Surgical correction of a keeled thorax is shown at the expressed cosmetic defect and progressing of extent of deformation at children 5 years are more senior. Various ways of a torakoplastika provide a subperikhondralny resection of parasternalny parts of edges, a cross sternotomiya, movement of a xiphoidal shoot and the subsequent fixing of a breast in normal situation by its sewing together with a nadkhryashchnitsa and the ends of edges.
At funneled a thorax conservative actions are shown only at the I extent of deformation; at II and III degrees surgical treatment is necessary. The optimum period for surgical correction of a funneled thorax the age of children from 12 to 15 years is considered. At the same time fixing of korrigirovanny position of forward department of a thorax can be carried out by means of external seams from metallic or synthetic threads; metal clamps; bone auto-or the allotransplantat left in a chest cavity or without their use.
Results of reconstruction of a thorax at children at its congenital deformation good in 80-95% of cases. A recurrence is celebrated at inadequate fixing of a breast, is more often at children with displastichesky syndromes.