Spering Christopher, Moerer Onnen, White Thomas W, Lehmann Wolfgang
Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.
Unfallchirurgie (Heidelb). 2024 Mar;127(3):171-179. doi: 10.1007/s00113-023-01400-2. Epub 2024 Jan 12.
The impact of energy on the thorax can lead to serial rib fractures, sternal fractures, the combination of both and to injury of intrathoracic organs depending on the type, localization and intensity. Sometimes this results in chest wall instability with severe impairment of the respiratory mechanics. In the last decade the importance of surgical chest wall reconstruction in cases of chest wall instability has greatly increased. The evidence for a surgical approach has in the meantime been supported by prospective randomized multicenter studies, multiple retrospective data analyses and meta-analyses based on these studies, including a Cochrane review. The assessment of form and severity of the trauma and the degree of impairment of the respiratory mechanism are the basis for a structured decision on an extended conservative or surgical reconstructive strategy as well as the timing, type and extent of the operation. The morbidity (rate of pneumonia, duration of intensive care unit stay and mechanical ventilation) and fatality can be reduced by a timely surgery within 72 h after trauma. In this article the already established and evidence-based algorithms for surgical chest wall reconstruction are discussed in the context of the current evidence.
能量作用于胸部可导致多发性肋骨骨折、胸骨骨折、两者合并存在，以及根据撞击类型、部位和强度导致胸内器官损伤。有时这会导致胸壁不稳定，严重影响呼吸力学。在过去十年中，手术重建胸壁在胸壁不稳定病例中的重要性大大增加。与此同时，前瞻性随机多中心研究、多项回顾性数据分析以及基于这些研究的荟萃分析（包括Cochrane综述）都支持了手术治疗方法。评估创伤的形式和严重程度以及呼吸机制的受损程度，是对扩展的保守或手术重建策略以及手术时机、类型和范围做出结构化决策的基础。创伤后72小时内及时进行手术可降低发病率（肺炎发生率、重症监护病房住院时间和机械通气时间）和死亡率。在本文中，将结合当前证据讨论已确立的、基于证据的胸壁重建手术算法。
