Kigawa I, Fukuda I, Fujii Y, Yamabuki K
Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Ibaraki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Jul;40(7):1116-20.
The reported patient was a 37-year-old male, who got a blunt chest trauma by a motor vehicle accident. Chest X-ray and computed tomography of the chest revealed bilateral multiple rib-fractures, pneumo-hemothorax, lung contusions, but no evidence of mediastinal hematoma. Since respiratory distress with a flail chest was observed, the patient was placed on an artificial ventilation, and thoracocentesis were also done on both sides, while the hemodynamics was fairly maintained with blood transfusion. On the 10th hospital day, however, he suddenly fell into a deep shock with the left hemothorax by changing the body position. Emergency thoracotomy demonstrated the laceration of the descending aorta, that was considered to be made by the sharp edge of the fractured left 8th rib, which correspondingly protruded into the thoracic cavity toward the aorta. The repair of the aortic injury and the resection of the rib edges were performed. He was discharged on the 45th hospital day. In cases with a blunt chest trauma, the majority of the causes of the traumatic aortic injury are reported to be "deceleration injury". Although the considered mechanism of the traumatic rupture of the thoracic aorta in this case is extremely rare, it should be taken into a consideration for treatment of the cases with a blunt chest trauma and multiple rib-fractures.
报告的患者为一名37岁男性，因机动车事故导致胸部钝性创伤。胸部X线和胸部计算机断层扫描显示双侧多发肋骨骨折、血气胸、肺挫伤，但无纵隔血肿迹象。由于观察到连枷胸伴呼吸窘迫，患者接受了人工通气，双侧也进行了胸腔穿刺，同时通过输血相当好地维持了血流动力学。然而，在住院第10天，他在改变体位时突然因左侧血胸陷入深度休克。急诊开胸手术显示降主动脉撕裂，认为是由左侧第8肋骨骨折的锐缘造成的，该肋骨相应地向胸腔内朝向主动脉突出。进行了主动脉损伤修复和肋骨边缘切除。他于住院第45天出院。在钝性胸部创伤病例中，据报道创伤性主动脉损伤的大多数原因是“减速损伤”。尽管该病例中创伤性胸主动脉破裂的推测机制极为罕见，但在治疗钝性胸部创伤和多发肋骨骨折病例时应予以考虑。
