Beauchamp G, Khalfallah A, Girard R, Dube S, Laurendeau F, Legros G
Am J Surg. 1984 Aug;148(2):292-5. doi: 10.1016/0002-9610(84)90240-x.
Diaphragmatic injury is often a missed diagnosis in patients with multiple trauma. For this reason, mortality can be high. From 1970 to 1981, 32 patients with diaphragmatic injuries were seen at Maisonneuve-Rosemont Hospital. Twenty-four of the patients (22 men and 2 women aged 18 to 79 years) had blunt abdominal or thoracic trauma causing diaphragmatic disruption. Rupture occurred 20 times on the left side of the diaphragm, and 3 times on the right side. There was one pericardiophrenic rupture. Motor vehicle accident was the most common cause of trauma. On arrival, 21 patients had acute diaphragmatic rupture. Clinical signs and radiography permitted early diagnosis in 15 patients, whereas diagnosis was made later in 3 other patients because of deterioration of vital signs. In two patients, diagnosis was made at laparotomy for another reason. Four patients were operated on for post-traumatic chronic diaphragmatic hernia. The abdominal approach was used in 18 patients, the thoracic approach in 4, and the thoracoabdominal approach in 2. Three patients died, two of whom had a late diagnosis. Fourteen patients had no complications. Diaphragmatic trauma can be easily managed surgically when diagnosis is made early after trauma. It must always be looked for in patients with multiple trauma.
膈肌损伤在多发伤患者中常常漏诊。因此，死亡率可能很高。1970年至1981年期间，麦松纳夫 - 罗斯蒙特医院共收治了32例膈肌损伤患者。其中24例患者（22名男性和2名女性，年龄在18至79岁之间）因钝性腹部或胸部创伤导致膈肌破裂。膈肌破裂发生在左侧20次，右侧3次，还有1次是心包膈破裂。机动车事故是最常见的创伤原因。入院时，21例患者存在急性膈肌破裂。15例患者通过临床体征和影像学检查得以早期诊断，另外3例患者因生命体征恶化而诊断较晚。2例患者因其他原因在剖腹手术时确诊。4例患者因创伤后慢性膈肌疝接受手术治疗。18例患者采用腹部入路，4例采用胸部入路，2例采用胸腹联合入路。3例患者死亡，其中2例诊断较晚。14例患者无并发症。如果在创伤后早期做出诊断，膈肌创伤可以通过手术轻松处理。对于多发伤患者，必须始终留意膈肌创伤。
