Objective To explore the causes of bar displacement after minimally invasive orthopaedic Nuss procedure for pectus excavatum,and to summarise the preventive and treatment measures.Methods A total of 17 patients admitted to Sichuan Provincial People's Hospital from June 2010 to February 2022 with bar displacement after Nuss procedure were selected into this study.Their clinical case data were retrospectively analysed to summarize the causes of bar displacement and its treatment measures.This study was approved by the Medical Ethics Committee of Sichuan Provincial People's Hospital(Approval No.2023-46).Informed consents were obtained from all patients or their guardians.Results ① The patients in this study were 15 males and 2 females,aged(12.8±4.7)years old(5.5-25.3 years old),with Haller index of 3.6±0.3(3.3-4.3).② Of the 17 patients in this study:14 cases had the bar flipping,1 case had the bar flipping combined with lateral sliding,and 2 cases had the dorsal shift of the bar(ages 25.3 and 18.3 years old,respectively);there were 13 cases of asymmetric pectus excavatum and 4 cases of symmetric type;and there were 12 patients whose age was＞12 years old.③ All 17 patients were reoperated to adjust the bar,and the bars were consolidate with stabilizer and medical stainless steel wire.Among them,2 cases were found to have bar flipping＞3 months after Nuss procedure,and the fixed plate was placed by replacing the rib gap after selecting a new incision to take out the plate;the remaining 15 cases were found to have bar displacement within 0-3 months after Nuss procedure,and the bar was relocated by replacing the rib gap through the original incision(4 cases)or reset the bar through the original incision with the original rib gap(11 cases)and re-fixed.④ Of the 17 patients in the study,6 cases had inappropriate bar placement,8 cases had confirmed or suspected history of strenuous activity or trauma after the Nuss procedure,13 cases had asymmetrical pectus excavatum,2 cases had severe sternal recess,and 12 cases were＞12 years old.Conclusions Appropriate age at the time of Nuss procedure in pectus excavatum patients,appropriate bar type and placement,and avoidance of premature strenuous activity or trauma after surgery are the main measures to reduce bar displacement after Nuss procedure.Once the postoperative bar displacement is found,it should be corrected and handled in a timely manner depending on the specific situation.
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