OSTEOSYNTHESIS FOR STERNAL FRACTURES : INDICATION AND SURGICAL PROCEDURE

• Published in: Journal of the Japanese Association for the Surgery of Trauma Vol. 36; no. 3; pp. 270 - 275
• Main Authors: YAGATA Yukihisa, TADA Keitaro, NAKAYAMA Haruki, IJUIN Shin-ichi, MATUYAMA Shigenari, ISHIHARA Satoshi, NAKAYAMA Shin-ichi
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本外傷学会 20.07.2022; The Japanese Association for the Surgery of Trauma
• Subjects: osteosynthesis; sternal fractures; surgical procedure; 手術手技; 胸骨骨折; 骨接合術
• ISSN: 1340-6264; 2188-0190
• DOI: 10.11382/jjast.36.3_04

Most sternal fractures are subject to conservative treatment, but cases for which osteosynthesis is indicated are rare. We investigated 8 cases of sternal fractures that were surgically treated at our facility. Seven cases of high-energy trauma involved serious comorbid trauma such as aortic injury and spinal injury. One case sustained with chest bruising was a single trauma of sternal fracture. The main reasons for the indication of surgery were marked displacement of the fracture in 6 cases and evaluation as a cause of respiratory insufficiency in 2 cases. In all cases, a spatula was inserted under the back side of the sternum to protect the cardiovascular system, and in 7 cases, two locking plates for facial bone fractures were placed side-by-side and fixed, and a T-plate was used for one case of unilateral fracture of the manubrium. The screws were inserted through the bone cortex of the back side of the sternum, and the median operation time and bleeding volume were 84 minutes and 74 ml, respectively. For different types of sternal fractures, it is desirable to select a flexible fixing method, mainly with locking plates for maxillofacial bone fractures. 　胸骨骨折の多くは保存的加療の対象となるが, 稀に骨接合術の適応となる症例を経験する. 自施設で手術加療を行った胸骨骨折8例について調査した. 高エネルギー外傷が7例で大動脈損傷や脊椎損傷など重篤な合併外傷がみられた. 胸部打撲によって受傷した1例は胸骨骨折単独外傷であった. 手術適応の主因は, 骨折部の転位が著しいもの6例, 呼吸障害の要因となっていると評価したもの2例であった. 手術は全例胸骨裏面にスパーテルを挿入して心大血管を保護した状態で操作し, 7例で2枚の顔面骨用ロッキングプレートを並べて固定, 柄部片側骨折の1例にはT字プレートを使用した. スクリューは胸骨裏面の骨皮質を貫通して挿入し, 手術時間と出血量は中央値でそれぞれ84分, 74mlであった. 多様な骨折型に対して, 顔面用プレートを主として, 臨機応変な固定方法を選択することが望ましい.