创伤性胸骨骨折43例临床诊治

Clinic experiences on diagnosis and therapy for 43 traumatic sternal fracture patients

目的总结创伤性胸骨骨折的临床诊治的经验。方法回顾性分析43例胸骨骨折患者的医疗记录、影像学资料和临床治疗的过程。结果损伤原因以交通伤、高坠伤多见;胸骨骨折损伤严重,合并伤多;无胸内大血管损伤和心源性休克发生;4例伴有胸椎骨折。4例死亡患者,1例死于大面积肺挫伤、连枷胸、ARDS;1例死于腹腔活动性出血,多脏器功能衰竭;2例死于颅脑外伤手术后。CT三维重建技术能够发现更多的胸骨骨折的影像学表现。10例患者进行胸骨内固定手术,效果良好,无并发症。结论稳定的、孤立性的胸骨骨折无需入院治疗;非稳定的或移位明显,有严重合并伤的胸骨骨折需入院监护和治疗;要重视合并伤的诊治。三维CT重建技术能够提高胸骨骨折诊断率。切开复位内固定术是矫正非稳定性胸骨骨折的安全、简易、有效的方法。

Objective The experiences on the management of traumatic sternal fracture were summarized.Methods The medical records and radiographs of 43 patients with traumatic sternal fracture admitted between June 2006 and December 2009 were retrospectively studied,including the characteristics of patients,causes of injury and associated injuries.Results Sternal fracture was mainly caused by traffic trauma and high fall injuries,resulting severe sternal injuries and significant associated injuries.One patient died from flail chest,massive pulmonary contusion and ARDS;one died from abdominal bleeding and MOF;two died from brain trauma.The others were survived.There was no great vessel injury and cardiac shock.Spiral CT and reconstruction technique could reveal more sternal fractures than plain film and CT scan could.Ten patients（23%） with severely displaced fracture underwent surgical treatment with no significant complications.Conclusion Admission to hospital is not necessary for patients having a stable and isolated sternal fracture and should be reserved for those with high-energy trauma,severely displaced fractures or significant associated injuries. Further investigations are necessary only when associated injury is suspected on clinical grounds.The clinical application of 3-D Spiral CT together with reconstruction technique improve the diagnosis of sternal fractures.Surgical stabilization by the simple and safe technique like open reduction and internal fixation of sternal fracture was recommended to the cases with severely displaced or unstable fracture.