Diarra O, Ba M, Ndiaye A ', Ciss G, Dieng P A, Sy M H, Diémé Ch, Ndiaye M
Service de Chirurgie Cardiovasculaire et Thoracique, Centre Hospitalier National de Fann, Dakar, Sénégal.
Dakar Med. 2007;52(3):231-5.
Traumatic manubriosternal joint dislocations are rare in adult and occur readily during a violent traumatism of the chest and/or the dorsal spine. We report two cases treated between September 1997 and August 2002 at the Surgical Emergency Department of Le Dantec Hospital. The first observation was related to a 26 year old lady. On September 27, 1997, she fell down from a tree and received all the weight of the body on her two arms. She was referred because of anterior chest pains, increasing with respiration associated with injuries of the 2 wrists. On conventional X-ray, a type II manubriosternal joint dislocation (anterior dislocation of the sternal body with respect to the manubrium) was diagnosed. The mechanism of the dislocation was indirect: flexion-compression of the sternum caused by a hyperflexion of the dorsal spine when the patient touched the ground. There was also a Pouteaux-Colles fracture of the 2 wrists. The dislocation was surgically treated: open reduction followed by manubriosternal stabilization using wires. The 2 wrists were treated by Kapandji procedure. At the 21st postoperative day, a traumatic rupture of the wires required a 2nd internal fixation of the sternum by wires. After 9 years, the patient is without complaint and the chest X-ray is normal. The second observation was that of a 19 year old young woman, referred on August 15, 2002 after a frontal crash with a car while crossing the road. She fell down on her back. She was complaining from severe posterior headaches with a normal Glasgow Scale (15), anterior chest and right hand pains. Radiological examinations showed a fracture of the occipital bone without embarrure and a type I manubriosternal joint dislocation (posterior displacement of the sternal body in relation to the manubrium) which mechanism was direct: direct shock against the sternum. There were also an isolated fracture of 4 right sided ribs and a fracture without displacement of the 3 last bones of the right metacarpus. An orthopaedic treatment was carried out for the lesions of the right hand and an abstention-monitoring suggested for the occipital fracture. The manubriosternal joint dislocation was surgically reduced and stabilized by using a braided polyester thread number 2. After 4 years, the patient is asymptomatic and the manobriosternal joint is stable. We emphasize on the scarcity and the mechanism of traumatic manubriosternal joint dislocations in adult, the frequency of associated injuries and the absence of consensus about their treatment.
创伤性胸骨柄体关节脱位在成年人中较为罕见，多在胸部和/或脊柱遭受暴力创伤时发生。我们报告1997年9月至2002年8月间在勒丹泰克医院外科急诊室治疗的两例病例。第一例是一位26岁女性。1997年9月27日，她从树上跌落，双臂承受了身体的全部重量。因前胸疼痛、随呼吸加重且伴有双腕部损伤而前来就诊。常规X线检查诊断为Ⅱ型胸骨柄体关节脱位（胸骨体相对于胸骨柄向前脱位）。脱位机制为间接性：患者着地时脊柱过度前屈导致胸骨的屈曲压缩。同时还存在双腕部的波泰-科莱斯骨折。脱位采用手术治疗：切开复位，然后用钢丝进行胸骨柄体固定。双腕部采用卡潘迪手术治疗。术后第21天，钢丝发生创伤性断裂，需再次用钢丝对胸骨进行内固定。9年后，患者无不适主诉，胸部X线检查正常。第二例是一位19岁年轻女性，2002年8月15日在过马路时与一辆汽车正面相撞后前来就诊。她背部着地摔倒。主诉严重的后头痛，格拉斯哥评分正常（15分），前胸和右手疼痛。影像学检查显示枕骨骨折无并发症，Ⅰ型胸骨柄体关节脱位（胸骨体相对于胸骨柄向后移位），脱位机制为直接性：胸骨直接受到撞击。还存在右侧4根肋骨单发骨折以及右手第3掌骨末节无移位骨折。对右手损伤进行了骨科治疗，枕骨骨折建议进行观察。胸骨柄体关节脱位通过使用2号编织聚酯线进行手术复位和固定。4年后，患者无症状，胸骨柄体关节稳定。我们强调成人创伤性胸骨柄体关节脱位的罕见性及其机制、相关损伤的发生率以及治疗上缺乏共识。
