Vodicka J, Spidlen V, Safránek J, Simánek V, Altmann P
Chirurgische Klinik des Universitätskrankenhauses Pilsen, Tschechische Republik.
Zentralbl Chir. 2007 Dec;132(6):542-6. doi: 10.1055/s-2007-981359.
Chest wall instabilities after extensive injuries of its skeleton belong to the most serious chest trauma with a relatively high rate of complications and mortality, mainly due to its pathophysiological consequences for the respiratory system.
Retrospective analysis of an almost ten year file of injured patients treated with surgical stabilisation using instrumentation from Medin a. s. Company, Nové Mesto na Morave.
From the end of 1997 to the middle of 2006, 40 patients were treated with metallic fixation of the chest by the authors; including 35 men and 5 women with an average age of 50.4 years. Almost x of the cases represented block fractures of the ribs, flail chest type, separately or in combination with a fracture of the sternum. Traffic accidents predominated in the mechanisms of injury (75 %). More then three fourth of chest instabilities resulted from severe polytrauma.
On average 4 plates were used for metallic fixation, 26 patients were indicated for the procedure directly due to chest wall instability; thoracotomy preceded in 9 patients with treatment of intrathoracic injury. Surgical stabilisation was performed in the mean on the 3.7 (th) day after injury. The period of subsequent artificial pulmonary ventilation usually did not exceed a week. One patient in the file died on sepsis due to bilateral bronchopneumonia (2.5 %), postoperative complications occurred in one fifth of patients, re-operation was performed in 16 patients. After a period of 11 months on average the implants were so far removed in 12 patients (30 %).
Our experience with metallic fixation of the unstable chest wall is mainly positive. Decisive for the success of this procedure is the correct indication respectively selection of patients that will have a benefit from the surgical stabilisation.
胸壁骨骼广泛损伤后的胸壁不稳定属于最严重的胸部创伤，并发症发生率和死亡率相对较高，主要是由于其对呼吸系统的病理生理影响。
回顾性分析近十年使用来自摩拉维亚新梅斯托的Medin a. s.公司的器械进行手术稳定治疗的受伤患者档案。
从1997年底至2006年年中，作者对40例患者进行了胸部金属固定治疗；其中包括35名男性和5名女性，平均年龄为50.4岁。几乎所有病例均为肋骨骨折块，连枷胸类型，单独或合并胸骨骨折。交通事故在损伤机制中占主导地位（75%）。超过四分之三的胸壁不稳定是由严重多发伤导致的。
平均使用4块钢板进行金属固定，26例患者直接因胸壁不稳定而接受该手术；9例患者在治疗胸内损伤之前先行开胸手术。手术稳定治疗平均在受伤后第3.7天进行。随后的人工通气时间通常不超过一周。档案中有1例患者因双侧支气管肺炎败血症死亡（2.5%），五分之一的患者出现术后并发症，16例患者进行了再次手术。平均11个月后，12例患者（30%）已取出植入物。
我们在不稳定胸壁金属固定方面的经验总体是积极的。该手术成功的关键在于正确的适应证，即分别选择能从手术稳定治疗中获益的患者。
