Igai Hitoshi, Kamiyoshihara Mitsuhiro, Nagashima Toshiteru, Ohtaki Yoichi
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan.
Ann Thorac Cardiovasc Surg. 2012;18(5):458-61. doi: 10.5761/atcs.cr.11.01759. Epub 2012 Feb 29.
The operative indications for rib fracture repair have been a matter of debate. However, several reports have suggested that flail chest, pain on respiration, and chest deformity/defect are potential conditions for rib fracture repair. We describe our experience of rib fixation in a patient with severe chest deformity due to multiple rib fractures. A 70-year-old woman was admitted with right-sided multiple rib fractures (2nd to 7th) and marked chest wall deformity without flailing caused by an automobile accident. Collapse of the chest wall was observed along the middle anterior axillary line. At 11 days after the injury, surgery was performed to repair the chest deformity, as it was considered to pose a risk of restrictive impairment of pulmonary function or chronic intercostal pain in the future. Operative findings revealed marked displacement of the superior 4 ribs, from the 2nd to the 5th, and collapse of the osseous chest wall towards the thoracic cavity. After exposure of the fracture regions, ribs fixations were performed using rib staplers. The total operation time was 90 minutes, and the collapsed portion of the chest wall along the middle anterior axillary line was reconstructed successfully.
肋骨骨折修复的手术指征一直存在争议。然而，一些报告表明，连枷胸、呼吸时疼痛以及胸壁畸形/缺损是肋骨骨折修复的潜在适应证。我们描述了对一名因多根肋骨骨折导致严重胸壁畸形患者进行肋骨固定的经验。一名70岁女性因汽车事故导致右侧多根肋骨骨折（第2至7肋）并伴有明显胸壁畸形但无连枷胸而入院。沿腋前线中部观察到胸壁塌陷。受伤11天后，由于考虑到未来存在肺功能限制性损害或慢性肋间疼痛的风险，遂进行手术修复胸壁畸形。手术所见显示第2至5肋上4根肋骨明显移位，骨性胸壁向胸腔塌陷。暴露骨折区域后，使用肋骨吻合器进行肋骨固定。总手术时间为90分钟，沿腋前线中部的胸壁塌陷部分成功重建。
