Guo Quanwei, Zhang Jinghui, Cai Kaican, Zhang Jianhua
Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, No.1333, Xinhu Road, Bao'an District, Shenzhen, 518101, Guangdong, China.
Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
BMC Surg. 2020 May 5;20(1):87. doi: 10.1186/s12893-020-00747-2.
Severe flail chest is a life-threatening situation. The Nuss procedure is a new effective treatment for severe flail chest patients who cannot be weaned from prolonged mechanical ventilation in the last few years. However, the procedure is not suitable when there are multiple fractures in both the anterior and lateral chest walls. Here, we reported a rare case of severe flail chest in a patient who suffered multiple fractures in both the anterior and lateral chest walls in a traffic accident.
A 49-year-old patient suffered severe flail chest by a steering wheel in a traffic accident with multiple fractures in both the anterior and lateral chest walls. In the beginning, the patient was administrated with mechanical ventilation because of acute respiratory distress syndrome (ARDS) for more than 1 week. Then the patient suffered from a severe lung infection and decreased blood oxygen saturation. After a multidiscipline discussion (MDT), three rib fixation plates were first used to rebuild the stability of lateral chest walls, then two Nuss bars were inserted to eliminate paradoxical movement in the anterior chest wall. Finally, the patient recovered smoothly after the combining procedure.
Severe flail chest patients with both the anterior and lateral chest walls after trauma are in a life-threatening situation, and require an appropriate procedure to get out of danger in time. Rib fixation is an effective treatment when the fractured sites are few and the fractured area is small. The Nuss procedure is a new effective method for severe flail chest with multiple fractures in an anterior chest wall, which is also a minimally invasive and short time-consuming procedure. However, it does not suitable for the patient with multiple fractures in lateral chest walls. Combining the use of Nuss procedure and rib fixation can solve severe flail chest with multiple ribs and sternum fractures in both the anterior and lateral chest walls, and the outcome of this procedure is satisfying in the present rare case.
严重连枷胸是一种危及生命的情况。近年来，努斯手术是治疗无法脱离长期机械通气的严重连枷胸患者的一种新的有效方法。然而，当胸壁前后侧均有多处骨折时，该手术并不适用。在此，我们报告了一例罕见的严重连枷胸病例，该患者在交通事故中胸壁前后侧均发生多处骨折。
一名49岁患者在交通事故中被方向盘撞击致严重连枷胸，胸壁前后侧均有多处骨折。起初，患者因急性呼吸窘迫综合征（ARDS）接受机械通气超过1周。随后患者发生严重肺部感染，血氧饱和度下降。经过多学科讨论（MDT），首先使用三块肋骨固定板重建胸壁外侧稳定性，然后插入两根努斯棒以消除胸壁前侧的反常运动。最终，联合手术后患者顺利康复。
创伤后胸壁前后侧均有骨折的严重连枷胸患者处于危及生命的状况，需要采取适当手术及时脱离危险。骨折部位少且骨折区域小的时候，肋骨固定是一种有效的治疗方法。努斯手术是治疗胸壁前侧多处骨折的严重连枷胸的一种新的有效方法，也是一种微创且耗时短的手术。然而，它不适用于胸壁外侧有多处骨折的患者。联合使用努斯手术和肋骨固定可以解决胸壁前后侧多处肋骨和胸骨骨折的严重连枷胸问题，在本罕见病例中该手术的效果令人满意。
