Matic Kieran J, Cheluvappa Rajkumar, Selvendran Selwyn
Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia.
Australian Catholic University, Watson, ACT 2602, Australia.
Healthcare (Basel). 2021 Apr 1;9(4):392. doi: 10.3390/healthcare9040392.
Surgical stabilisation of rib fractures (SSRF) reduces morbidity and mortality. However, its impact in complicated cases, particularly those with underlying thoracic pathologies, is of continued interest. Electronic records were retrospectively reviewed after obtaining informed consent from the patient. This case report details a patient with chronic, residual, Stanford Type A aortic dissection (AD) who had multiple left-sided rib fractures with a flail segment after being struck by a bicycle. The preoperative computed tomography (CT) of the patient's chest showed that the sixth posterior rib fracture location was just ~13 mm from the false lumen of the aorta. As the patient had poor respiratory output and persistent pain, SSRF was not performed on the posterior sections. However, the anterior third to seventh rib fractures were plated. The patient recovered fully, with reduced pain and improved respiratory function. This is the first report describing the benefits of SSRF with AD or major thoracic pathologies. Further research into the benefits of SSRF in specific thoracic pathologies may lead to improved patient outcomes. This may require the creation of profiles of patient cohorts with relevant clinical history to determine if SSRF may benefit patients with specific thoracic pathologies.
肋骨骨折的手术固定（SSRF）可降低发病率和死亡率。然而，其在复杂病例，尤其是伴有潜在胸部病变的病例中的影响，仍备受关注。在获得患者知情同意后，对电子病历进行了回顾性审查。本病例报告详细介绍了一名患有慢性、残留性斯坦福A型主动脉夹层（AD）的患者，该患者在被自行车撞击后出现多根左侧肋骨骨折并伴有连枷胸段。患者胸部的术前计算机断层扫描（CT）显示，第六后肋骨折部位距离主动脉假腔仅约13毫米。由于患者呼吸功能差且疼痛持续，未对后段进行SSRF。然而，对第三至第七前肋骨折进行了钢板固定。患者完全康复，疼痛减轻，呼吸功能改善。这是第一份描述SSRF对AD或主要胸部病变有益的报告。对SSRF在特定胸部病变中的益处进行进一步研究可能会改善患者的治疗效果。这可能需要创建具有相关临床病史的患者队列档案，以确定SSRF是否可能使患有特定胸部病变的患者受益。
