Zhao Weigang, He Weiwei, Yang Yi, Zhao Yonghong
Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
AME Case Rep. 2021 Jan 25;5:8. doi: 10.21037/acr-20-96. eCollection 2021.
Thoracic aortic injury is fatal but rare in blunt chest trauma, which usually requires urgent surgical treatment. It is mostly caused by posterior rib fractures. Chest wall stabilization (CWS) has been widely performed in patients with multiple rib fractures all over the world in the past two decades with satisfactory outcomes. However, the surgical treatment of posterior rib fracture within 2-3 cm from transverse process is still a difficult problem for thoracic surgeons. Under this circumstance, rib-transverse process internal fixation method was developed and widely performed for above patients at present. In this article, we presented a case of thoracic aortic injury caused by multiple rib fractures. A 54-year-old female was admitted to our hospital with dyspnea and severe chest pain caused by a falling object. Thoracic aortic injury with multiple rib fractures were diagnosed basing on image date and emergency CWS was performed for this patient. Rib-transverse process internal fixation was not performed in this case since the patients combined with transverse process fracture. We firstly performed transverse process resection combined with CWS for this patient. The results of our study showed this method is safe and feasible for patients with multiple rib fractures combined with transverse process fracture.
胸主动脉损伤在钝性胸部创伤中虽致命但罕见，通常需要紧急手术治疗。其大多由后肋骨折引起。在过去二十年里，胸壁固定术（CWS）在全世界范围内已广泛应用于多根肋骨骨折患者，效果令人满意。然而，对于距离横突2 - 3厘米以内的后肋骨折，其手术治疗仍是胸外科医生面临的难题。在这种情况下，肋骨 - 横突内固定方法应运而生，目前已广泛应用于上述患者。在本文中，我们展示了一例由多根肋骨骨折导致胸主动脉损伤的病例。一名54岁女性因重物砸伤致呼吸困难和严重胸痛入院。基于影像学资料诊断为胸主动脉损伤合并多根肋骨骨折，并对该患者实施了紧急胸壁固定术。由于该患者合并横突骨折，此病例未行肋骨 - 横突内固定术。我们首先对该患者实施了横突切除术并联合胸壁固定术。我们的研究结果表明，对于多根肋骨骨折合并横突骨折的患者，该方法安全可行。
