Anyanwu C H, Umeh B U, Swarup A S
Br J Surg. 1987 Mar;74(3):181-3. doi: 10.1002/bjs.1800740308.
Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25.6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.
创伤性膈肌破裂是一种潜在的严重损伤，其表现形式因致伤机制不同而各异。在7年的时间里，我们科室共收治了20例创伤性膈肌破裂患者（男17例，女3例）；他们的平均年龄为25.6岁。65%的病例中膈肌损伤由汽车事故所致，10%由从树上跌落引起。10例患者（50%）在受伤后7天内就诊，95%在3个月内就诊。85%的病例左侧半膈肌破裂，15%为右侧破裂。14例患者（70%）有肋骨骨折，共50根肋骨骨折，但无骨盆骨折。14例患者（70%）有胃肠道脏器疝入胸腔，其中胃、大网膜、结肠和脾脏是最常见的疝入器官。18例患者手术修复成功，其中4例还进行了脾切除术；2例患者接受了保守治疗。对于创伤性膈肌破裂，无论有无腹部脏器疝入，高度的怀疑指数和早期手术治疗是成功治疗的关键。
