Richardson J David, Franklin Glen A, Heffley Susan, Seligson David
Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
Am Surg. 2007 Jun;73(6):591-6; discussion 596-7.
Chest wall fractures, including injuries to the ribs and sternum, usually heal spontaneously without specific treatment. However, a small subset of patients have fractures that produce overlying bone fragments that may produce severe pain, respiratory compromise, and, if untreated mechanically, result in nonunion. We performed open reduction and internal fixation on seven patients with multiple rib fractures-five in the initial hospitalization and two delayed--as well as 35 sternal fractures (19 immediate fixation and 16 delayed). Operative fixation was accomplished using titanium plates and screws in both groups of patients. All patients with rib fractures did well; there were no major complications or infections, and no plates required removal. Clinical results were excellent. There was one death in the sternal fracture group in a patient who was ventilator-dependent preoperatively and extubated himself in the early postoperative period. Otherwise, the results were excellent, with no complications occurring in this group. Three patients had their plates removed after boney union was achieved. No evidence of infection or nonunion occurred. The excellent results achieved in the subset of patients with severe chest wall deformities treated initially at our institution and those referred from outside suggest that operative fixation is a useful modality that is likely underused.
胸壁骨折，包括肋骨和胸骨损伤，通常无需特殊治疗即可自行愈合。然而，一小部分患者的骨折会产生覆盖其上的骨碎片，可能导致严重疼痛、呼吸功能受损，若不进行机械治疗，会导致骨不连。我们对7例多根肋骨骨折患者进行了切开复位内固定术，其中5例在初次住院时进行，2例延迟手术，同时对35例胸骨骨折患者进行了手术（19例即刻固定，16例延迟固定）。两组患者均使用钛板和螺钉进行手术固定。所有肋骨骨折患者恢复良好；无重大并发症或感染发生，无需取出钢板。临床效果极佳。胸骨骨折组有1例患者死亡，该患者术前依赖呼吸机，术后早期自行拔管。除此之外，该组效果极佳，无并发症发生。3例患者在骨愈合后取出了钢板。未发现感染或骨不连迹象。在我们机构最初治疗的以及从外部转诊来的严重胸壁畸形患者亚组中取得的优异结果表明，手术固定是一种有用的治疗方式，但可能未得到充分应用。
