Bergmann L
Z Erkr Atmungsorgane. 1984;163(1):75-9.
The pathogenesis and the causal atraumatic mechanism of uni- and bilateral stress fractures of the first rib in 4 cases of young men will be discussed. In 3 cases the discovery of these fractures has been the result of mass x-ray survey alone without complaints by the patients. As a causal factor there must be supposed a permanent strain and (or) an overstrain of the mm. scaleni. At a 15-year-old schoolboy we found a combination of bilateral fracture of the first rib and bilateral spontaneous pneumothorax. In this case we suppose that an overstrain of the mm. scaleni medius and anterior is responsible for the fractures of the rib, and an abrupt distension of the pleural cupola by the m. scalenus minimus - occurring among 72% of all European children - for spontaneous pneumothorax. Minimal subpleural emphysematous bullae adherent to the pleural cupola might be ruptured by this distension. This mechanism is probably also responsible for other cases of spontaneous pneumothorax, in which no stronger physical strains of the patient were preceding.
将讨论4例年轻男性第一肋单侧和双侧应力性骨折的发病机制及无创伤性病因机制。3例中，这些骨折的发现仅是大规模X线检查的结果，患者并无相关主诉。作为病因，必须假定存在斜角肌的持续劳损和（或）过度劳损。在一名15岁的男学生中，我们发现了第一肋双侧骨折与双侧自发性气胸并存的情况。在这种情况下，我们认为中斜角肌和前斜角肌的过度劳损导致肋骨骨折，而小斜角肌使胸膜顶突然扩张（在所有欧洲儿童中发生率为72%）导致自发性气胸。贴附于胸膜顶的最小的胸膜下肺气肿性大疱可能因这种扩张而破裂。这种机制可能也是其他自发性气胸病例的病因，在这些病例中患者之前并无更强的身体劳损情况。
