Makey Ian A, Jacob Samuel, El-Sayed Ahmed Magdy M, Pham Si, Landolfo Kevin, Thomas Mathew
Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
Trauma Case Rep. 2019 Nov 4;24:100247. doi: 10.1016/j.tcr.2019.100247. eCollection 2019 Dec.
Surgical stabilization of fractured ribs has been shown to improve trauma related outcomes, however the procedure itself can be a source of morbidity. This report details two cases of latissimus dorsi muscle sparing sub-scapular multi-rib fracture plating. We combined several techniques to make this possible. The first technique was use of a vertical skin incision along the anterior border of the latissimus muscle. The second was the use of a mammary retractor to provide adequate and sustained retraction of the latissimus and scapula. The third was utilization of a right angle screwdriver to allow placement of the posterior screws. Sparing the latissimus muscle for sub-scapular fractures is possible but requires planning and extra equipment to perform. Minimizing rib fixation related morbidity makes it a more appealing treatment.
肋骨骨折的手术固定已被证明可改善创伤相关结局，然而该手术本身可能是发病的一个来源。本报告详细介绍了两例保留背阔肌的肩胛下多根肋骨骨折钢板固定术。我们结合了多种技术才使这成为可能。第一种技术是沿背阔肌前缘做垂直皮肤切口。第二种是使用乳腺牵开器，以充分并持续牵开背阔肌和肩胛骨。第三种是使用直角螺丝刀来置入后方螺钉。对于肩胛下骨折保留背阔肌是可行的，但需要规划和额外的设备来实施。将肋骨固定相关的发病率降至最低使其成为一种更具吸引力的治疗方法。
