Stefani Alessandro, Tormen Francesco, Scamporlino Adriana, Natali Pamela, Cavallesco Giorgio, Morandi Uliano
Division of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
Division of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Int J Surg Case Rep. 2021 Apr;81:105805. doi: 10.1016/j.ijscr.2021.105805. Epub 2021 Mar 22.
Flail chest is now usually treated by conservative methods and surgical fixation remains indicated in selected cases. Different techniques can be used for fixation. The aim of this paper is to present a case in which Judet and Sanchez-Loret plates were employed and to discuss the usefulness of this traditional technique.
A 79-year-old woman was admitted for left thoracic trauma with severe antero-lateral flail chest. She was affected by COPD with chronic respiratory failure, ischemic heart disease, autoimmune thrombocytopenia treated on chronic steroid therapy and severe osteoporosis. CT-scan detected multiple rib fractures, left hemothorax and lung contusions. An initial conservative treatment of flail chest involved compressive bandage and then internal pneumatic stabilization in ICU, but it failed. The patient underwent successful surgical treatment of the flail chest by fixation of the anterior fractures from the second to the eight rib. Judet and Sanchez-Lloret plates were used. A bilateral pneumonia developed during the rehabilitation period and the patient died two months after operation.
Judet and Sanchez-Lloret plates represent a traditional technique for fixation of flail chest. This technique is less and less used and progressively replaced by newer materials, especially titanium plates with screws or intramedullary struts. Our patient had multiple comorbidities and a very fragile bones that advised against use of screws or intramedullary struts.
Judet and Sanchez-Lloret plates can be still considered a useful tool for the fixation of flail chest in cases of thin and fragile bones.
连枷胸目前通常采用保守方法治疗，在某些特定情况下仍需进行手术固定。可使用不同的技术进行固定。本文旨在介绍一例使用朱代（Judet）钢板和桑切斯 - 洛雷（Sanchez-Loret）钢板的病例，并探讨这种传统技术的实用性。
一名79岁女性因左胸外伤伴严重前外侧连枷胸入院。她患有慢性阻塞性肺疾病（COPD）并伴有慢性呼吸衰竭、缺血性心脏病、自身免疫性血小板减少症且正在接受慢性类固醇治疗以及严重骨质疏松症。CT扫描发现多处肋骨骨折、左侧血胸和肺挫伤。连枷胸最初的保守治疗包括加压包扎，随后在重症监护病房（ICU）进行内部充气稳定治疗，但失败了。患者通过固定第二至第八肋骨的前部骨折成功接受了连枷胸手术治疗。使用了朱代钢板和桑切斯 - 洛雷钢板。康复期间发生了双侧肺炎，患者术后两个月死亡。
朱代钢板和桑切斯 - 洛雷钢板是连枷胸固定的传统技术。这种技术的使用越来越少，并逐渐被更新的材料所取代，尤其是带螺钉的钛板或髓内支柱。我们的患者有多种合并症且骨骼非常脆弱，不建议使用螺钉或髓内支柱。
对于骨骼薄且脆弱的连枷胸固定病例，朱代钢板和桑切斯 - 洛雷钢板仍可被视为一种有用的工具。
