连枷胸的诊治进展

Advances in diagnosis and treatment for flail chest

连枷胸是严重胸部伤的一种,多合并肺实质的损伤,容易引起急性呼吸窘迫综合征和呼吸衰竭。胸部X线片、多层螺旋CT是诊断连枷胸和肺挫伤的良好方法。连枷胸的治疗措施较复杂,合理采用保持气道通畅、控制浮动胸壁、呼吸机辅助治疗、镇痛、限制性液体复苏和胸壁手术内固定等综合治疗措施是提高疗效的关键。越来越多的研究显示,胸壁内固定手术治疗,与非手术治疗比较,具有很多优点,但需严格掌握手术时机和适应证。

Flail chest is a common blunt chest injury ,and is often complicated with injury of lung parenchy-ma,acute respiratory distress syndrome （ ARDS） and respiratory failure .Chest X-ray film and multiple-slice spiral computerized tomography scan are useful diagnostic methods for flail chest and pulmonary contusion .The compre-hensive managements of flail chest with pulmonary contusion include keeping airway unobstructed ,floating chest wall control,artificial ventilation,pain control,limited fluid resuscitation and internal rib fixation in time .More and more studies have shown the advantages of open reduction internal fixation （ORIF） over operative management .However, the timing and indications of surgery should be strictly grased .