Flancbaum L, Dauber M, Demas C, Boyarsky A H, Trooskin S Z
Division of Trauma Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903.
Am Surg. 1988 Apr;54(4):195-9.
Diaphragmatic rupture following blunt torso trauma is an infrequent injury often posing a considerable diagnostic challenge. Between June 1984 and July 1986, nine patients sustaining rupture of the diaphragm due to blunt trauma were treated. All were injured in high-speed motor-vehicle accidents. Six patients arrived in shock (SBP less than or equal to 95 mm Hg). All patients had multiple associated injuries; mean ISS = 41.5. Eight patients (89%) had associated intra-abdominal injuries, the spleen being injured most frequently (63%). Associated thoracic injuries occurred in six patients (67%). The admission CXR was abnormal in eight patients (89%) but diagnostic of diaphragmatic rupture in only four. DPL was positive in four of five patients (80%) and falsely negative in one. Seven ruptures were left-sided, one right-sided and one involved the central tendon. All injuries were diagnosed shortly after admission and successfully repaired via a transabdominal approach. One patient died as a result of a massive subdural hematoma. Blunt diaphragmatic rupture is an indication of a high-energy insult and is usually associated with other major organ system injuries. An aggressive approach to the management of the multiply injured patient can result in early recognition and successful treatment of this injury.
钝性胸部创伤后膈肌破裂是一种罕见的损伤，常常带来相当大的诊断挑战。在1984年6月至1986年7月期间，对9例因钝性创伤导致膈肌破裂的患者进行了治疗。所有患者均在高速机动车事故中受伤。6例患者入院时处于休克状态（收缩压小于或等于95mmHg）。所有患者均有多处合并伤；平均损伤严重度评分（ISS）为41.5。8例患者（89%）有腹腔内合并伤，其中脾脏损伤最为常见（63%）。6例患者（67%）有胸部合并伤。8例患者（89%）入院时胸部X线检查异常，但只有4例诊断为膈肌破裂。5例患者中有4例（80%）诊断性腹腔灌洗（DPL）结果为阳性，1例为假阴性。7例破裂位于左侧，1例位于右侧，1例累及中央腱。所有损伤在入院后不久均被诊断出来，并通过经腹途径成功修复。1例患者因巨大硬膜下血肿死亡。钝性膈肌破裂表明受到了高能量损伤，通常与其他主要器官系统损伤相关。对多发伤患者采取积极的治疗方法可实现对该损伤的早期识别和成功治疗。
