外傷性肋骨骨折・胸骨骨折に対するプレート固定

Experience with Surgical Stabilization for Traumatic Rib Fractures and Sternal Fractures

肋骨骨折・胸骨骨折は，交通事故や転落・転倒などによる鈍的外傷が主な原因であり，日常診療でしばしば遭遇する．気胸・血胸・縦隔血腫を併発し，強い疼痛により胸郭運動制限，喀痰喀出困難などを引き起こして，無気肺や肺炎といった呼吸器合併症を起こしうるため，迅速かつ適切な対応が求められる．保存的治療が主体であるが，海外を中心に選択された症例において外科治療が施行され，良好な成績が報告されつつある．

The treatment of traumatic rib fractures and sternal fractures have focused on pain and respiratory management, and conservative treatment has been recommended. Recently, however, a number of case series from abroad have been reported and demonstrated the usefulness of surgical stabilization of rib fractures （SSRF） and sternal fractures （SSSF）. We have experienced seven cases of SSRF and two cases of SSSF at International University Health and Welfare Narita Hospital and Atami Hospital. Based on our experienced cases, we have outlined the preoperative evaluation, indication for surgery, timing of surgery, surgical techniques, and postoperative course. Of these nine cases, the clinical course of two cases of SSRF and one case of SSSF were detailly presented. The surgical indications and techniques for traumatic rib fractures and sternal fractures vary from institution to institution, and there is no single optimal treatment. We hope that the accumulation of cases, and discussions will help to build a higher quality evidence for surgical treatment of thoracic trauma in Japan.