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Bibliometric and clinical review of nuss bar stabilization techniques: a four-phase evolution toward lower bar
Meng Chen1, Yimin Xie1, Bin Chen1
1Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, 404016, China.
Purpose:
Bar displacement remains one of the most clinically significant complications of the Nuss procedure for pectus excavatum. To our knowledge, no bibliometric analysis has systematically mapped the research landscape of bar stabilization methods. This study combines bibliometric analysis with clinical systematic review to fill this gap.
Methods:
A dual-database retrieval from Web of Science Core Collection (WoSCC) and PubMed identified publications on Nuss bar stabilization (1998-2025). Following PRISMA 2020 guidelines, 283 publications were included for bibliometric analysis using VOSviewer, CiteSpace, and R-bibliometrix, and 42 core studies were selected for clinical systematic review. Six fixation categories encompassing 19 techniques were analyzed.
Results:
Publications showed exponential growth across four phases. The USA (31.1%) and South Korea (20.0%) led research output. Journal of Pediatric Surgery and Pediatric Surgery International were identified as Zone 1 core journals. Keyword burst detection revealed a shift from "wire fixation" (2003-2012) to "bridge fixation" and "zero displacement" (2015-2025). Displacement rates decreased from 15% (no stabilizer) to 0% in the largest single-center bridge-fixation series.
Conclusion:
Among the techniques reviewed, bridge fixation is associated with the lowest reported displacement rates across the approximately 6,500 patients in the 42 studies reviewed, achieving 0% in the largest single-center series (Level III evidence, predominantly retrospective data from a single high-volume center; one RCT available). Adequately powered multicenter trials and formal cost-effectiveness analyses are the field's most pressing needs.
