Kaplan Daniel J, Begly John, Tejwani Nirmal
Trauma Division, NYU Langone Orthopedics, NYU Hospital for Joint Diseases, New York, NY.
J Orthop Trauma. 2017 Aug;31 Suppl 3:S34-S35. doi: 10.1097/BOT.0000000000000910.
Rib fractures are a common chest injury that can typically be treated nonoperatively. However, a percentage of these will go on to nonunion, either because of unique characteristics of the fracture itself or because of a variety of poor healing factors of the host. If a patient has continued symptomology beyond 3 months, surgeons may consider operative management.
Although isolated resection of fibrous scar tissue from the nonunion site may be sufficient in some cases, it may also be necessary to provide additional structural integrity to the rib depending on the extent of the fracture pattern and resection. This goal can be achieved operatively with rib plating and bone grafting to promote healing.
This video demonstrates the use of plating in the treatment of rib nonunion. It begins with relevant background information on rib fractures and nonunions, then details the approach, open reduction and internal fixation of 3 ribs using plates and bone graft aspirate. Pearls and pitfalls are included during the surgical technique aspect of the video to both help guide surgeons new to the procedure and provide potentially advantageous technical details to more experienced surgeons.
肋骨骨折是一种常见的胸部损伤，通常可采用非手术治疗。然而，其中一定比例的骨折会出现不愈合，这要么是由于骨折本身的独特特征，要么是由于宿主的多种不利于愈合的因素。如果患者在3个月后仍有持续症状，外科医生可能会考虑手术治疗。
虽然在某些情况下，从骨折不愈合部位单独切除纤维瘢痕组织可能就足够了，但根据骨折类型和切除范围，可能还需要为肋骨提供额外的结构完整性。这一目标可通过肋骨钢板固定和植骨手术来促进愈合。
本视频展示了钢板固定在肋骨骨折不愈合治疗中的应用。视频首先介绍了肋骨骨折和不愈合的相关背景信息，然后详细介绍了使用钢板和自体骨移植吸出物对3根肋骨进行切开复位内固定的方法。视频在手术技术环节中包含了要点和陷阱，既有助于指导初次接触该手术的外科医生，也为经验更丰富的外科医生提供了潜在的有利技术细节。
