Croce E J, Mehta V A
J Thorac Cardiovasc Surg. 1979 Jun;77(6):856-7.
The patient described in this report had the initial symptoms and signs of a fractured right ninth rib followed soon by severe signs of trauma to the local chest wall. In the ensuing 5 months sequella suggesting an intercostal hernia gradually developed. Further studies indicated that this hernia consisted of a posterior pleural and anterior peritoneal component. At operation the diaphragm was found to have torn away from its costal attachments. In addition to repairing the intercostal pleural hernia, we recommend that a strip of Marlex mesh be fixed to the inner costal surfaces to form a continuous and durable new attachment for the diaphragmatic margin prior to the repair of the peritoneal component. Determining a probable explanation for the mechanism of the injury was helpful in understanding the reconstruction procedure.
本报告中描述的患者最初表现为右第九肋骨骨折的症状和体征，随后很快出现局部胸壁严重创伤的体征。在接下来的5个月里，逐渐出现提示肋间疝的后遗症。进一步检查表明，该疝由后胸膜和前腹膜成分组成。手术时发现膈肌已从其肋附着处撕脱。除了修复肋间胸膜疝外，我们建议在修复腹膜成分之前，将一条Marlex网片固定在内侧肋表面，为膈肌边缘形成连续且持久的新附着。确定损伤机制的可能解释有助于理解重建过程。
