Raab Stephan, Grieser Thomas, Sturm Manfred, Beyer Michael, Reindl Sebastian
Zentralbl Chir. 2019 Jun;144(3):305-321. doi: 10.1055/a-0774-3401. Epub 2019 Jun 5.
The therapy of rib fractures is controversially discussed. Neither does an osteosynthesis have to be performed for each individual rib fracture, nor is the internal splinting by ventilation or respiratory therapy sufficient for each patient. Rib fractures are common in polytrauma patients after car and motorcycle accidents or falls from great heights. However, rib fractures are also increasingly occurring in older patients with falls from low heights. Anamnesis and clinical examination are groundbreaking for the diagnosis and therapy decision of rib fractures. In radiological diagnostics, projection radiography comes first, followed by sonography and CT. Computed tomography should be required for planning an operation. Accompanying injuries must be taken into account when deciding on therapy. We see a complicated organ injury, dislocated rib serial fractures, flail chest and respiratory insufficiency as indications for rib stabilization. As a relative indication for rib stabilization, we see a high suffering pressure due to pain and an intrathoracic volume restriction due to dislocated rib serial fractures. New osteosynthesis material and minimally invasive techniques standardize the procedure and minimize surgical trauma. In any case, adequate pain and respiratory therapy are always crucial for successful treatment.
肋骨骨折的治疗存在争议。并非每一例肋骨骨折都必须进行骨固定术,而且通气或呼吸治疗进行的内固定对每位患者也并不足够。肋骨骨折在汽车和摩托车事故或高处坠落导致的多发伤患者中很常见。然而,在从较低高度坠落的老年患者中肋骨骨折也越来越多地出现。病史和临床检查对于肋骨骨折的诊断和治疗决策至关重要。在放射诊断中,首先是投照X线摄影,其次是超声检查和CT。计划进行手术时应采用计算机断层扫描。决定治疗方案时必须考虑伴随损伤。我们将复杂的器官损伤、肋骨连环骨折脱位、连枷胸和呼吸功能不全视为肋骨固定的指征。作为肋骨固定的相对指征,我们认为因疼痛导致的高痛苦程度以及因肋骨连环骨折脱位导致的胸腔容积受限。新型骨固定材料和微创技术使手术过程标准化并将手术创伤降至最低。无论如何,充分的疼痛和呼吸治疗对于成功治疗始终至关重要。