Jones H K, McBride G G, Mumby R C
Orlando Regional Medical Center, FL 32806-2093.
J Trauma. 1989 Mar;29(3):360-4. doi: 10.1097/00005373-198903000-00014.
Twenty-eight cases of sternal fractures and/or dislocations were reviewed for the presence of associated spinal injury. Patient records and radiographs were studied. Sixteen cases had inadequate radiographs to rule out spine fracture. Three cases had known direct injuries to the sternum. Of the remaining nine patients, eight had spine fractures. All of the spine fractures were consistent with a flexion injury mechanism. Three patients had spine fractures at the thoracic level and four at the lumbar level. One patient had lower cervical and thoracic injuries. In the patients with spine injury, the proximal manubrial fragment tended to displace posteriorly. Similarly, the manubrium would move posteriorly in manubriosternal dislocations. A case of spontaneous sternal fracture in a patient with osteoporosis and multiple thoracic compression fractures is described. One patient had open reduction of the manubriosternal joint. Three patients who were admitted for their sternal injuries had spine fractures which were not recognized during the hospitalization. There were no cases of mediastinal injury in the patients with combined sternal and spinal injuries. Flexion injury to the spine may cause buckling of the sternum. However, indirect sternal injury continues to be overlooked. Careful evaluation for spine injuries should be done on all patients with sternal fractures and vice versa.
回顾了28例胸骨骨折和/或脱位病例，以确定是否存在合并脊柱损伤。研究了患者记录和X线片。16例患者的X线片不足以排除脊柱骨折。3例患者有已知的胸骨直接损伤。在其余9例患者中，8例有脊柱骨折。所有脊柱骨折均符合屈曲损伤机制。3例患者为胸椎水平脊柱骨折，4例为腰椎水平脊柱骨折。1例患者有下颈椎和胸椎损伤。在脊柱损伤患者中，胸骨柄近端骨折块往往向后移位。同样，在胸骨柄胸骨关节脱位时，胸骨柄也会向后移动。描述了1例骨质疏松症和多发胸椎压缩骨折患者的自发性胸骨骨折。1例患者接受了胸骨柄胸骨关节切开复位术。3例因胸骨损伤入院的患者有脊柱骨折，但住院期间未被发现。合并胸骨和脊柱损伤的患者中无纵隔损伤病例。脊柱屈曲损伤可能导致胸骨弯曲。然而，间接胸骨损伤仍被忽视。对所有胸骨骨折患者都应仔细评估脊柱损伤，反之亦然。
