Keeled thorax (keeled deformation of a thorax, chicken breast, KGDK) – pathology at which a forward part of a thorax acts, getting a form of boat Kiel. Is congenital anomaly, it is descended, shown in process of growth of the patient. Men suffer more often than women. It is rather often combined with system pathology of connecting fabric. In itself does not exert negative impact on work of internals, however can be followed by narrowing of a thorax. It is shown by visible deformation of a forward part of a thorax (edges and a breast). For specification of the diagnosis, definition of type and extent of deformation carry out a X-ray analysis and KT. Conservative treatment is ineffective. For elimination of cosmetic defect surgeries are carried out.
Keeled thorax – congenital deformation of a thorax, the second for prevalence, after a funneled breast. Makes about 7% of total number of violations of a form of a forward chest wall. Men suffer 4 times more often than women. In 26% hereditary predisposition comes to light, in 15% the combination to Marfan's syndrome, congenital heart diseases, scoliosis and other diseases of connecting fabric is noted. Treatment of keeled deformation of a thorax is performed by thoracic surgeons, and in the small settlements which do not have the thoracic centers – traumatologists and orthopedists.
Reasons and pathogenesis
Keeled thorax – a hereditary congenital malformation. In some cases joint inheritance of a keeled and funneled breast therefore some researchers assume the general nature and the mechanism of development of these anomalies comes to light. Besides, connection between existence of KDGK, a constitution of patients and a condition of their connecting fabric is authentically established. In most cases patients with keeled deformation of a thorax have the high growth and an asthenic constitution.
At a part of patients pathology of a thorax is combined with Marfan's syndrome – the system disease caused by pathology of connecting fabric and including a dolikhostenomiyeliya (high growth), an arakhnodaktiliya (the extended arachnoid fingers), an underdevelopment of fatty cellulose, hyper mobility of joints, violations from cardiovascular system and organs of vision. Perhaps also combination to congenital heart diseases and skoliotichesky deformation of a backbone.
At the child's birth anomaly of a thorax is usually hardly noticeable, however in process of growth deformation progresses, and cosmetic defect which expressiveness can strongly vary is formed over time. Functional violations from respiratory organs and blood circulation in the first years of life are not expressed. A part of children of advanced age shows complaints to short wind, bystry fatigue and heartbeat at intensive physical activity. At the same time objective violations can come to light: increase in minute volume of breath, decrease in coefficient of consumption of oxygen and vital capacity of lungs.
The listed violations, as a rule, are caused not by the deformation, and the accompanying features (asthenic type of a constitution, the narrowed thorax, congenital heart diseases). Now most of experts consider that the keeled breast in itself does not involve negative consequences in the form of violation of work of heart and lungs and is purely cosmetic defect.
There is a large number of classifications of KDGK, but the fullest and almost significant is Fokin and Bairov's option:
- Kostalny type. The curvature of a breast is absent or is poorly expressed and has rotational character. Deformation is formed at the expense of a bend of costal cartilages of a kpereda.
- Manubriokostalny type. The breast handle together with 2-3 jointed costal cartilages is bent kpered, and the breast body with a xiphoidal shoot is displaced kzad.
- Korpokostalny type. Two options are possible. The first – the breast is dugoobrazno curved forward in the lower and average third, costal cartilages are bent knutr. The second – the breast is slantwise directed forward and from top to bottom and stuck most out in the lower third.
Both symmetric, and asymmetric deformation can be observed. In the second case because of the wrong development of edges the breast is bent on an axis.
The shape of a thorax is broken at the expense of the breast acting forward, a forward part of a breast will stand forward. At most of patients cartilaginous parts IV-VIII of edges sink down from one or two parties. Usually the characteristic turn of edges of costal arches comes to light. The thorax is significantly increased in the perednezadny direction, changes of the perednezadny size at respiratory excursions are reduced in comparison with norm or are practically absent. From outside looks as though the thorax constantly is in a condition of a breath.
The diagnosis is exposed on the basis of data of survey, for specification like deformation and expressiveness of changes the thorax X-ray analysis in a side projection and a computer tomography is appointed. At suspicion of pathology from heart and lungs necessary researches are conducted: the spirography, the ECG, Ekho-KG etc., are appointed consultations of the cardiologist and the pulmonologist. At Marfan's syndrome the comprehensive examination including consultations of the orthopedist, the cardiologist, the pulmonologist, the ophthalmologist and the neurologist is shown.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Among the people far from medicine, popular belief that keeled deformation of a thorax can be corrected by means of physiotherapy exercises, respiratory gymnastics and physical exercises. Unfortunately, experts hold other opinion – it is possible to restore a normal form of a thorax only with use of surgical techniques. All other methods only improve physical shape of the patient (that is also important, especially at the expressed adynamy, existence of diseases of connecting fabric and pathology of cardiovascular system).
Proceeding from the aforesaid, and also that the keeled breast is mostly purely cosmetic defect it is clear that the optimum result at treatment of this pathology can achieve, having only defined the priorities having the greatest value for the specific patient. At identical type and extent of deformation for one patient it will be more important to restore a normal psychological background and a self-assessment, having performed operation, for another – to improve the general condition of an organism, having appointed course LFK and the all-strengthening treatment.
As, unlike funneled, keeled deformation of a thorax does not exert obvious negative impact on functioning of bodies and systems of the patient, the only indication to surgical correction is the urgent need of the patient for elimination of cosmetic defect. At the same time doctors recommend to resort to expeditious treatment only in extreme cases. There are two main surgical techniques of treatment of a keeled breast: low-invasive intervention by Abramson's method and operation on Mark Ravich's method with open access.
At surgical intervention across Ravich the doctor carries out a cross-section under dairy glands / pectoral muscles and cuts pectoral muscles and direct muscles of a stomach from places of an attachment. Then rezetsirut costal cartilages and sews the remained nadkhryashchnitsa, reducing intercostal intervals and removing a breast in physiologic situation. At the expressed deformation the wedge-shaped sternotomiya in addition is carried out.
Open surgeries by Kondrashin's method (a cross sternotomiya with a resection of area of deformation and movement of edges), and also a metallosternokhondroplastika across Timoshchenko are less often applied. Now, along with the listed traditional methods more and more popular is a low-invasive operation on Abramson. When using this technique the doctor makes two sections 3-4 cm long on each side, hems to edges of a plate and fixes to these plates one more – correcting. A metalwork deletes in several years, after full correction of keeled deformation and rearrangement of a thorax.
In the presence of contraindications to operation, and also in cases when the patient is dissatisfied with appearance of the thorax, but does not agree to the listed surgical interventions, the methods allowing to modify esthetic perception of a body without correction of a shape of a thorax are offered. To men recommend to pump up pectoral muscles, and – to establish to women silicone implants of mammary glands. It does not eliminate deformation, but does it less noticeable.
In recent years a number of domestic thoracic surgeons offers patients non-invasive correction with use of compression system of Ferre. This technique can be used only at early age when bones and cartilages still rather flexible, and are assumed by carrying the special device. It should be noted that this system is not certified in Russia yet, and devices should be ordered abroad. One more lack of this method is need to carry the device within several years. Children rather hard postpone a procedure, and end of a course of treatment is "reached" by only a half of patients. Besides, because of long pressure skin in a breast can become thinner and become excessively pigmented.