Chihara K, Hitomi S, Kobayashi J, Kawarasaki S, Mizuno H
Department of Thoracic Surgery, Kyoto University, Japan.
Nihon Geka Gakkai Zasshi. 1991 Sep;92(9):1363-6.
Anterolateral multiple rib fractures near xiphoid process impaired mechanical linkage which resists distortion between pulmonary (upper) and abdominal (lower) rib cage resulting in flail chest. Repair of fractured ribs with ceramic pins improved phase shift between the diaphragm and the rib cage and the amplitude of the injured rib cage motion, and decreased rib cage distortion. Asymmetrical motion of lower rib and upper abdomen which suggested impairment of the diaphragm action on the abdominal rib cage was found in three patients whose emphysematous bullae were located in the middle and lower lung fields, and disappeared after bullectomy. To control the pressure in the pleural cavity after pneumonectomy from excessive negative pressure to atmospheric pressure with SF6 improved pulmonary function. Chest wall function can be preserved on the basis of functional anatomy and physiology of the chest wall.
剑突附近的前外侧多发性肋骨骨折破坏了机械联动，这种联动可抵抗肺（上）和腹部（下）胸廓之间的变形，从而导致连枷胸。用陶瓷钉修复肋骨骨折改善了膈肌与胸廓之间的相位偏移以及受伤胸廓运动的幅度，并减少了胸廓变形。在3例肺气肿大疱位于中下肺野的患者中发现下肋骨和上腹部的不对称运动，提示膈肌对腹部胸廓的作用受损，肺大疱切除术后这种运动消失。用六氟化硫将肺切除术后胸腔内的压力从过度负压控制到大气压可改善肺功能。胸壁功能可基于胸壁的功能解剖学和生理学得以保留。
