Wasylenko M J, Busse E F
Can J Surg. 1981 Nov;24(6):626-7.
A 24-year-old man severely injured in a motor vehicle accident was found to have, on the right side, a pneumothorax, extrapleural hematoma, acromioclavicular dislocation and fracture of the first three ribs and of the transverse processes of C7 and T1. Through a right thoracotomy, transection of the right main stem bronchus and a laceration of the left main stem bronchus were discovered. These were repaired. Twenty days after admission, posterior dislocation of the clavicle at the sternum was noted. A diagnosis of tracheoesophageal fistula was made on the 32nd day but the symptoms had been sternoclavicular and acromioclavicular dislocations. At autopsy the medial end of the clavicle was found to be torn from its articular discand and locked behind the manubrium. The fistula was behind the posterior capsule between the carina and esophagus. The authors conclude that continued pressure from the displaced clavicle may have led to delayed necrosis of the esophagus and that reduction of the dislocated clavicle might have saved the patient's life.
一名24岁男性在机动车事故中受重伤，右侧被发现有气胸、胸膜外血肿、肩锁关节脱位以及第1至3肋骨和第7颈椎及第1胸椎横突骨折。通过右胸切开术，发现右主支气管横断以及左主支气管裂伤，并进行了修复。入院20天后，发现锁骨在胸骨处后脱位。第32天诊断出气管食管瘘，但症状一直是胸锁关节和肩锁关节脱位。尸检发现锁骨内侧端从关节盘撕裂并锁在胸骨柄后方。瘘管位于隆突和食管之间的后囊后方。作者得出结论，移位锁骨持续施加的压力可能导致食管延迟性坏死，而复位脱位的锁骨或许可以挽救患者生命。
