Mazzella Antonio, Fournel Ludovic, Bobbio Antonio, Janet-Vendroux Aurélie, Lococo Filippo, Hamelin Emelyne Canny, Icard Philippe, Alifano Marco
Thoracic Surgery Department, Paris Center University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France.
Department of Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
J Thorac Dis. 2020 Jan;12(1):10-16. doi: 10.21037/jtd.2019.07.83.
Slipping rib syndrome is an overlooked cause of low chest or upper abdominal pain. Costal cartilage excision has been described as an effective treatment of this disorder. We review our experience with surgically treated slipping rib syndrome in the adult patient.
This is a single institution retrospective analysis from January 2000 to March 2019 of adult patients operated on for treatment of a slipping rib syndrome.
Nineteen patients were diagnosed with slipping rib syndrome and underwent costal cartilage excision. All patients presented with unilateral and life disturbing chest pain (8 left sided). In all cases, point tenderness was observed with palpation and hooking maneuver was positive. Each patient underwent imaging and ultrasonography suggested slipping rib syndrome in one case. A mean of 1±0.2 cartilages was excised. Early postoperative course was uneventful in all the cases. Follow-up was complete for all patients over a median of 18.7±12 [3-132] months. At postoperative month 2 follow-up, 15 on 19 patients had complete resolution of their symptoms. At late interviews, 6 out of 19 patients described recurrent pain, whose intensity was significantly lower. We observed significant differences about pre-operative and post-operative visual analog pain (EVA) (8.07±0.75 2±2.3, P<0.005), weekly pain crises (6.25±2.7 1.6±2.1, P<0.005) and morphinics consomption (9/19 2/19, P=0.029). Fourteen patients out of 19 nineteen strongly recommended surgical intervention.
Slipping rib syndrome of the adult is an overlooked cause of chest or abdominal pain which diagnosis and treatment are often delayed. Costal cartilage excision allows short to mid-terms effective and reliable treatment to reduce symptoms and life disturbance but does not exclude late pain recurrence.
肋软骨滑综合征是下胸部或上腹部疼痛的一个被忽视的原因。肋软骨切除术已被描述为治疗这种疾病的有效方法。我们回顾了我们在成年患者中手术治疗肋软骨滑综合征的经验。
这是一项单机构回顾性分析，研究对象为2000年1月至2019年3月因肋软骨滑综合征接受手术治疗的成年患者。
19例患者被诊断为肋软骨滑综合征并接受了肋软骨切除术。所有患者均表现为单侧且困扰生活的胸痛（8例为左侧）。所有病例触诊时均有压痛，钩拉试验阳性。每位患者均接受了影像学检查，超声检查仅1例提示肋软骨滑综合征。平均切除1±0.2块软骨。所有病例术后早期过程均顺利。所有患者均完成随访，中位随访时间为18.7±12 [3 - 132]个月。术后第2个月随访时，19例患者中有15例症状完全缓解。在后期随访中，19例患者中有6例描述有复发性疼痛，但其强度明显较低。我们观察到术前和术后视觉模拟疼痛评分（VAS）（8.07±0.75对2±2.3，P<0.005）、每周疼痛发作次数（6.25±2.7对1.6±2.1，P<0.005）和吗啡消耗量（9/19对2/19，P = 0.029）存在显著差异。19例患者中有14例强烈推荐手术干预。
成人肋软骨滑综合征是胸痛或腹痛的一个被忽视的原因——其诊断和治疗常常延迟。肋软骨切除术可实现短期至中期有效且可靠的治疗，以减轻症状和对生活的干扰，但不能排除后期疼痛复发。
