Benyan A S, Korymasov E A, Medvedchikov-Ardiya M A
Samara State Medical University, Samara, Russia.
Seredavin Samara Regional Clinical Hospital, Samara, Russia.
Khirurgiia (Mosk). 2023(8):46-53. doi: 10.17116/hirurgia202308146.
To analyze the incidence and structure of late complications after blunt chest trauma, feasibility of surgical correction and effectiveness of these interventions.
Treatment outcomes were analyzed in 26 patients with late complications of blunt chest wall trauma. Severe chest deformities were diagnosed in 8 patients, non-union rib fracture - 5, pulmonary hernia - 4, chronic abscesses and pseudocysts of soft tissues of the chest - 3, osteomyelitis of the ribs - 3, chronic recurrent pulmonary bleeding following damage to lung parenchyma by rib fragments - 2, persistent post-traumatic pleuritis - in 1 patient.
Among 26 patients, 23 ones underwent surgical correction of complications. Reconstructive procedures were performed in 5 out of 8 patients with post-traumatic chest deformities. In 5 patients with non-union rib fractures, surgery consisted of resection of ribs, excision of capsule and scar tissue, osteosynthesis. Thoracic pulmonary hernia required thoracotomy, viscerolysis, chest wall defect closure by bringing together the ribs and fixing with pulley sutures or ZipFix system. In 2 patients, pulmonary hernia was combined with non-union rib fracture. These patients underwent additional resection of false joints and osteosynthesis. Three patients were diagnosed with chronic abscesses and pseudocysts of soft tissues of the chest. Surgical treatment was carried out according to the principles of staged debridement of chronic purulent foci. Osteomyelitis of ribs in 3 patients required resection within intact tissues. Fixation of ribs by metal structures was not performed in these patients, and we performed only muscle and soft tissue repair. Conservative treatment was carried out in 3 patients with chest deformity. There were no lethal outcomes.
Pathological syndromes in long-term period after blunt chest trauma require surgical correction. Surgical treatment of patients with late complications of chest trauma should be aimed at chest stabilization, improving respiratory function and preventing secondary and tertiary complications. Osteosynthesis allows not only to eliminate pathological syndromes, but also increase tolerance to physical activity and quality of life.
分析钝性胸部创伤后晚期并发症的发生率、结构、手术矫正的可行性及这些干预措施的有效性。
对26例钝性胸壁创伤晚期并发症患者的治疗结果进行分析。8例患者诊断为严重胸部畸形，5例为肋骨不愈合骨折，4例为肺疝，3例为胸部软组织慢性脓肿和假性囊肿，3例为肋骨骨髓炎，2例为肋骨碎片损伤肺实质后慢性复发性肺出血，1例为持续性创伤后胸膜炎。
26例患者中，23例接受了并发症的手术矫正。8例创伤后胸部畸形患者中有5例进行了重建手术。5例肋骨不愈合骨折患者的手术包括肋骨切除、包膜和瘢痕组织切除、骨固定。胸肺疝需要开胸手术、粘连松解、通过拉拢肋骨并用滑轮缝线或ZipFix系统固定来闭合胸壁缺损。2例患者肺疝合并肋骨不愈合骨折。这些患者接受了额外的假关节切除和骨固定。3例患者诊断为胸部软组织慢性脓肿和假性囊肿。根据慢性化脓病灶分期清创的原则进行手术治疗。3例肋骨骨髓炎患者需要在完整组织内进行切除。这些患者未进行金属结构肋骨固定，仅进行了肌肉和软组织修复。3例胸部畸形患者接受了保守治疗。无死亡病例。
钝性胸部创伤长期后的病理综合征需要手术矫正。胸部创伤晚期并发症患者的手术治疗应旨在稳定胸部、改善呼吸功能并预防继发性和三级并发症。骨固定不仅可以消除病理综合征，还可以提高对体力活动的耐受性和生活质量。
