Okamoto Keigo, Ueda Keiko, Ichinose Masutarou
Department of General Thoracic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
Department of General Thoracic Surgery, Rakuwakai Otowa Hosipital, 2 Chinji-cho Otowa, Yamashina, Kyoto, 607-8062, Japan.
Respir Med Case Rep. 2019 Apr 16;27:100840. doi: 10.1016/j.rmcr.2019.100840. eCollection 2019.
Most rib fractures are treated conservatively, but patients with severe trauma may require surgical treatment. We report a rare case of delayed pericardial injury due to a fractured rib stump.
A 61-year-old man fell while riding a bicycle and was transferred to our hospital. A computed tomography (CT) scan showed mild rib fractures on the 4th-6th ribs, and he was hospitalized because of acute pain. A few days later, his respiratory condition had worsened. CT showed that the rib fractures progressed significantly, and the stump was in contact with the heart, so we performed an urgent surgical rib fixation. Operative findings revealed intrathoracic hemorrhage by the pericardial laceration because of the rib stump. The 4th-7th ribs were internally fixed using a screwless titanium metal plate, and he was discharged without complications on the 20th postoperative day.
We experienced a rare case of pericardial injury caused by a rapid dislocation of rib fractures. Urgent surgical treatment was able to prevent a serious complication.
大多数肋骨骨折采用保守治疗，但严重创伤患者可能需要手术治疗。我们报告一例因肋骨骨折残端导致的迟发性心包损伤罕见病例。
一名61岁男性骑自行车时摔倒，被送至我院。计算机断层扫描（CT）显示第4至6肋骨轻度骨折，因急性疼痛住院。几天后，他的呼吸状况恶化。CT显示肋骨骨折明显进展，骨折残端与心脏接触，因此我们进行了紧急手术肋骨固定。手术发现因肋骨残端导致心包撕裂引起胸腔内出血。使用无螺钉钛金属板对第4至7肋骨进行内固定，术后第20天他无并发症出院。
我们遇到一例因肋骨骨折快速移位导致心包损伤的罕见病例。紧急手术治疗能够预防严重并发症。
