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Association of Braces and Exercises to Vacuum Bell for the Treatment of Pectus Excavatum

Davi de Podestá Haje

Centro Clínico Orthopectus and Hospital de Base do Distrito Federal, Brazil

 

Haje S.A. described in 1988 the possibility of treating the pectus excavatum (PE) by a non-surgical way, using braces and exercises. Intending to improve the results of pectus excavatum (PE) treatment with the use of braces and exercises (DRM-dynamic remodeling method), the vacuum bell (VB) was associated. Flexibility was noted as very-flexible (F3), F2, F1 and rigid (F0). Patients had DRM when: PE bothered aesthetically, worsening or/and association with spine deformities. VB was associated to DRM when: slow/poor results in the first 4-8 months of DRM or immediate start associated with DRM (motivated patients). The results were annotated as: R0(no response); R1(0-39% improvement); 40-69%(R2) and R3(>70%). The DRM was regularly when: braces used >18 hours/day+ exercise (> 5 times/week). Photographs were taken at the same angles before and at the final follow-up. One hundred and seventeen patients began treatment with DRM (55% were F0-F1), and the VB association was indicated in 31 patients. Twenty-one started VB (m13.1 years, 71% F1/ F0). Three patients did not return, 6 patients had R1 results (m12,1years), 9 R2(m15,52y) and 3 R3(m7,77y). The R1,R2 and R3 patients fulfilled DRM during 5.33, 11.1 and 16.7 months, respectively. VB was initiated on average 7.3 months (0-17months) after the start DRM. Those who had used regularly VB for more than 6 months (n=10), the result was increased by 10-30% in half of cases, and the rest remained unchanged. In patients under the age of 10 (4 children, being 3 with regular DRM and F0),VB seemed to help increase the final result of R2 to R3 (20%-30% additional improvement). Patients who stopped DRM or let it irregular after acquisition of VB, the additional improvement was at most 10% in adolescents, except in a case of a 5 years old girl that improved her result in about 30% using regular VB and 10 hours/day braces. The association of regular use of DRM and VB was more effective than isolated regular use of VB (associated or not to irregular DRM). The associated regular use of VB and DRM in F0 cases appears to be more effective than in cases where DRM is regular and isolated, particularly in younger patients. In the present study 57% of pectus excavatum patients had good or excellent results (R2-R3). Using only brace and exercises Haje DP et all reported R2-R3 results in 31 to 40% of pectus excavatum cases. The use of VB associated with DRM increased the PE treatment outcomes in some cases.

Keywords: Braces, vacuum bell, pectus excavatum, orthoses