Skerget B, Macura S, Korosec B, Jost I
Acta Chir Iugosl. 1982;29(2):189-97.
Authors present 3 cases with stable osteosynthesis of the ribs in unstable chest. An operative technique of osteosynthesis with the reconstruction by an Ao-plate and screws K-3.5 has been shown. Indications for applying of stable osteosynthesis have been stressed, and are as follows:--unstable chest following injuries--polytrauma combined bu unstable chest,--open fractures of the ribs (when the space between the fragment is not too large),--injuries of the lungs, combined with the injury of the ribs create unstability of the chest,--pseudoarthrosis of many ribs, or permanently unstable chest,--when a respirator is not available, this treatment is mandatory. Authors have experimentally examined and compared the value of OS with the plate of Judet and they described the advantages, as well as disadvantages (poor fixation, migration of the plate danger of eventual injury of intercostal arteries a.o.). The results of two patients were excellent, while the third one died 5 weeks following the surgery, due to other causes. Although the internal stabilization of the chest with the aid of the respirator is a proved method, a lasting hospitalization is frequently complicated by this treatment; all this represents a basis for a new approach: AO plate, and an emergency osteosynthesis immediately following injury; this gives the best results so that authors consider it as revolutionary progress in the treatment of such injuries.
作者介绍了3例不稳定胸部肋骨稳定内固定的病例。展示了使用AO钢板和K-3.5螺钉进行重建的内固定手术技术。强调了稳定内固定的应用指征，如下：——创伤后不稳定胸部；——合并不稳定胸部的多发伤；——肋骨开放性骨折（骨折块间间隙不太大时）；——肺部损伤合并肋骨损伤导致胸部不稳定；——多根肋骨假关节形成或胸部长期不稳定；——没有呼吸机时，这种治疗是必需的。作者通过实验检查并比较了使用Judet钢板进行内固定的价值，描述了其优点以及缺点（固定不佳、钢板移位、有损伤肋间动脉等的风险）。两名患者的结果良好，而第三名患者术后5周因其他原因死亡。尽管借助呼吸机进行胸部内固定是一种已证实的方法，但这种治疗常导致长期住院并引发并发症；所有这些构成了一种新方法的基础：AO钢板，伤后立即进行急诊内固定；这能取得最佳效果，因此作者认为这是此类损伤治疗中的革命性进展。
