Emory University School of Medicine, Atlanta, GA, USA.
Grady Health System, Atlanta, GA, USA.
Am Surg. 2024 Apr;90(4):695-702. doi: 10.1177/00031348231209530. Epub 2023 Oct 18.
The anterior stove-in chest (ASIC) is a rare form of flail chest involving bilateral rib or sternal fractures resulting in an unstable chest wall that caves into the thoracic cavity. Given ASIC has only been described in a handful of case reports, this study sought to review our institution's experience in the surgical management of ASIC injuries.
A retrospective review of patients with ASIC was conducted at our level I trauma center from 1//2021 to 3//2023. Information pertaining to patient demographics, fracture pattern, operative management, and outcomes was obtained and compared across patients in the case series.
6 patients met inclusion criteria, all males aged 37-78 years. 5 suffered motor vehicle collisions, and 1 was a pedestrian struck by an automobile. The median injury severity score was 28. All received ORIF within 5 days of admission, most commonly for ongoing respiratory distress. Patients 2 and 4 underwent bilateral ORIF of the ribs and sternum while patients 1, 5, and 6 underwent left-sided repair. Patient 3 required ORIF of left ribs and the sternum to stabilize their injuries. 5 of 6 patients were liberated from the ventilator and survived to discharge.
This study demonstrates successful operative management of 6 patients with ASIC and suggests that early operative intervention with ORIF for affected segments may improve respiratory mechanics, ability to wean from the ventilator, and overall survival. Further research is needed to generate standardized guidelines for the management of this uncommon and complex thoracic injury.
前炉胸（ASIC）是一种罕见的连枷胸形式，涉及双侧肋骨或胸骨骨折，导致不稳定的胸壁向内塌陷到胸腔。鉴于 ASIC 仅在少数病例报告中描述过，本研究旨在回顾我们机构在 ASIC 损伤的手术治疗方面的经验。
对我们的一级创伤中心自 2021 年 11 月至 2023 年 3 月期间的 ASIC 患者进行回顾性研究。获取并比较了病例系列中患者的人口统计学、骨折模式、手术管理和结果相关信息。
6 名符合纳入标准的患者均为男性，年龄 37-78 岁。5 名患者遭受机动车碰撞，1 名行人被汽车撞击。损伤严重程度评分中位数为 28。所有患者均在入院后 5 天内接受了 ORIF，最常见的原因是持续的呼吸窘迫。患者 2 和 4 接受了双侧肋骨和胸骨的 ORIF，而患者 1、5 和 6 则接受了左侧修复。患者 3 需要进行左侧肋骨和胸骨的 ORIF 以稳定其损伤。6 名患者中有 5 名从呼吸机中解放出来并存活出院。
本研究证明了对 6 名 ASIC 患者进行成功的手术治疗，并表明早期手术干预（ORIF）对受累节段可能改善呼吸力学、脱机能力和整体生存率。需要进一步研究以制定这种罕见且复杂的胸部损伤的标准化管理指南。
