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Funnel chest deformity is the most common malformation of the anterior chest wall, which in many cases leads to cardiorespiratory disorders and psychological problems. The undisputed progress in her treatment is the Nuss procedure, which is the «gold standard». However, this surgical operation and its modifications carry potential risks of severe postoperative and intraoperati. The aim is analyzation the existing variants of Nuss procedure and developing our own modification of this kind of surgery to eliminate intraoperative risks, reduce the level of postoperative complications, minimize postoperative pain. Materials and methods. In 2018–2019, the authors operated on 34 patients with funnel chest (Nuss operation in its own modification) with II and III degrees of deformity. The analysis of postoperative complications, the level of postoperative pain on the NRSP scale up to 3 months after surgery; duration of interventions, volume of intraoperative bleeding are made. Features of the proposed modification of the operation are: 1) Using of a monolithic T-shaped titanium bar with a removable stabilizer; 2) Formation of the tunnel is strictly under the muscles; 3) Rigid subperiostal fixation of bar stabilizers to two ribs on each side; 4) Using bars of different width for different age categories; 5) As a device for gradual dosed intraoperative lifting of the sternum used a turnbuckle; 6) The working port is entered through the right main access and through the right subpectoral tunnel; 7) Correction of asymmetric forms of deformation is carried out due to asymmetric rigid fixation of stabilizers and traction of the sternum by several ligaturesve complications. Results. The proposed modification of the Nuss operation reduces intra- and postoperative risks: only one postoperative complication was registered (2.9%); the method fixation of bar avoids the risks of eruption, displacement and reversal of the bar (no case has been registered), significantly reduces postoperative pain and prevents its chronicity. In all cases of correction of asymmetric forms of deformation it was possible to achieve good aesthetic results with the installation of one fixing bar. Conclusions. Gradual traction of the sternum to the position of moderate hypercorrection eliminates the risk of manipulation in the retrosternal space; subperiostal fixation of the bar to two ribs on each side guarantees reliable fixation of the plate without the risk of its displacement and reversal. Smaller bar thickness and width; fixing it as an arched structure reduces injuries of intercostal vascular nerve bundles and ribs and reduces postoperative pain. Placing the working port at the point of exit of the bar from the right pleural cavity facilitates and ensures manipulation in the mediastinum, providing sufficient elevation of the sternum. When using the proposed modification in most cases, it is sufficient to install one correction bar. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: Nuss procedure, funnel chest, postoperative complications, postoperative pain syndrome, intraoperative lifting of sternum, turn-buckle, fixation of bar, thoracoscopy.

Проведено аналіз консервативного лікування 58 пацієнтів із кільоподібною деформацією грудної клітки із використанням брейс-системи оригінальної конструкції; ця група хворих зверталася по медичну допомогу з листопада 2015 р. по червень 2018 року. Також проведено аналіз хірургічного лікування 111 пацієнтів із кільоподібною деформацією грудної клітки, котрим була проведена операція Абрамсона у модифікації Д.І. Шульги. Хворі оперовані у період 2009-2018 років. В усіх випадках із закінченим лікуванням при консервативному підході настало одужання; в усіх пацієнтів із незавершеним консервативним лікуванням визначена позитивна динаміка і продовжується лікування. В одному випадку виявлена тенденція до рецидивування, що потребувало відновлення лікування на 4 місяці. Відзначені певні переваги власної конструкції динамічної компресійної брейс-системи. Запропонована аналогічна брейс-система для корекції супутньої протрузії реберних дуг, вперше використана брейс-система для корекції кільоподібної деформації у дівчат-підлітків та жінок; висвітлено перший досвід комплексного симультанного консервативного лікування кільоподібної деформації грудної клітки, поєднаної з виразними ступенями кіфозу, сколіозу та кіфосколіозу. Визначені особливості, переваги передньої мініінвазивної торакопластики за Абрамсоном-Шульгою. Визначено хороший функціональний та косметичний результат оперативного лікування в усіх випадках. Запропонована фіксуюча дуга-пластина власної конструкції. Проведено аналіз функціонального стану кардіореспіраторної системи до та після лікування. Зроблено порівняльний аналіз результатів консервативного та хірургічного лікування. Ключові слова: кільоподібна деформація грудної клітки, консервативне лікування, мініінвазивне хірургічне лікування, динамічна компресійна брейс-система.

The most common surgery for the correction of congenital funnel chest in the 21st century is the Nuss procedure. This intervention is accompanied by complications related to the actual fixing bar and its size and placement and methods of fixing. The most common of these are bar displacement and chronic postoperative pain. Only one size of corrective bar (thickness, width) is used for this type of operation in all age groups. Purpose – to develop and implement the original modification of the Nuss procedure with individual calculation of the minimum dimensions of the corrective bar; to eliminate the probability of bar displacement; reduce the duration and intensity of postoperative pain. Materials and methods. The original method of the correcting titanium bar fixing as a monolithic metal arched structure with rigidly fixed ends was used in the study, the subperiostal fastening of the bar stabilizers to two ribs on each side was used. This method was used to operate on 34 patients with funnel chest aged from 6 to 17 years. Results. Mathematical modeling of the functioning of the correcting bar as a monolithic metal arched structure with rigidly fixed ends and determination of its strength and rigidity were performed. As an example, when calculating the stiffness of a plate with a width of 12 mm and a thickness of 2.2 mm under the use of a load of 25 kg (250 N) and an arch width of 20 cm, we determine the deflection of the bar 3.57 mm, strength factor 1.8. The loads of 250 N are much higher than those that actually exist. The cases of depression of the thorax (deflection of the bar) and cases of eruption of the bar were non indicated. The analyzis the level of postoperative pain syndrome on the NRSP scale for 4–5 days after surgery in patients with II degree of funnel chest determined an average score of 3.74; with III degree – 4.18; after one month of the operation – 1.0 and 1.63, respectively. Chronic postoperative pain was not noted. Conclusions. Rigid subptriostal fixation of the bat stabilizers to two ribs on each side prevents the plate from shifting. The proposed method of mathematical modeling of plate dimensions allows to individually calculate the dimensions of the correcting bar, providing in the vast majority of cases the correction of deformation bars 10, 11, 12 mm. The intensity and duration of the pain syndrome is much less than in standard technique due to the redistribution of pressure on the fulcrums of the bar and the absence of injury to the intercostal nerves, reducing the size of the plate. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Zhytomyr Regional Pediatric Clinical Hospital of the Zhytomyr Regional Council, Ukraine. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Nuss procedure, funnel chest, fixing bardimensions, method of fixation.