초록접수 현황
| 14F-210 | 포럼 발표 |
The Alternative use of Nuss Bar for Surgical Stabilization of a Sternal Flail Chest
정유영, 한성준, 이연주, 강신광, 나명훈, 유재현, 임승평, 강민웅
Department of Thoracic and Cardiovascular Surgery, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
Background : Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. Traditional treatment of flail chest is internal pneumatic fixation with full sedation for 7 to 14 days. But it is associated with ventilator dependency and ventilator related complication. Several surgical modalities such as Judet plate, rib fixation, were introduced. However, it related with postoperative complications, larger incision, and cost effectiveness. We report alternative use of Nuss bar for surgical stabilization of the flail chest for old age or severe comorbidities.
Methods : From February 2011 to March 2013, 8 patients were performed Nuss bar insertion for flail chest. Nuss bar insertion was performed as same manner as Nuss procedure. Nuss bar inserted at the level of paradoxical thoracic cage movement. The medical records were retrospectively reviewed for the injury severity score, the mean preoperative time of ventilation, the postoperative length of ventilator, the length of intensive care unit stay and survival.
Results : All trauma mechanisms are car accidents. The median age of patients was 71.75±12 years old (range, 54-94 years) and male was 4. The mean ISS(injury severity score) was 41.13±8.88, the mean preoperative time of ventilation was 7.62±7.83 days, and the mean postoperative length of ventilator was 4.5±3.46 days. 3 of 8 patients who ventilated more than 7 days prior to Nuss bar insertion showed prolonged postoperative length of ventilator support and intensive care unit stay. 5 of 8 patients underwent Nuss bar insertion within 4 days of ventilation and showed early weaning from ventilator support(8.66±1.69 versus 2±0.89 days, p=0.006) and short intensive unit stay (13.33±2.49 versus 3.8±1.46 days, p=0.007). There is one case of mortality (1/8) due to delayed intracranial hemorrhage.
Conclusion : The Nuss bar insertion for flail chest enabled surgical stabilization of chest wall and re-expansion of the lung. Early surgical intervention for flail chest shows good outcome. Nuss bar insertion could be a good treatment modality for traumatic flail chest in selected patients.
Methods : From February 2011 to March 2013, 8 patients were performed Nuss bar insertion for flail chest. Nuss bar insertion was performed as same manner as Nuss procedure. Nuss bar inserted at the level of paradoxical thoracic cage movement. The medical records were retrospectively reviewed for the injury severity score, the mean preoperative time of ventilation, the postoperative length of ventilator, the length of intensive care unit stay and survival.
Results : All trauma mechanisms are car accidents. The median age of patients was 71.75±12 years old (range, 54-94 years) and male was 4. The mean ISS(injury severity score) was 41.13±8.88, the mean preoperative time of ventilation was 7.62±7.83 days, and the mean postoperative length of ventilator was 4.5±3.46 days. 3 of 8 patients who ventilated more than 7 days prior to Nuss bar insertion showed prolonged postoperative length of ventilator support and intensive care unit stay. 5 of 8 patients underwent Nuss bar insertion within 4 days of ventilation and showed early weaning from ventilator support(8.66±1.69 versus 2±0.89 days, p=0.006) and short intensive unit stay (13.33±2.49 versus 3.8±1.46 days, p=0.007). There is one case of mortality (1/8) due to delayed intracranial hemorrhage.
Conclusion : The Nuss bar insertion for flail chest enabled surgical stabilization of chest wall and re-expansion of the lung. Early surgical intervention for flail chest shows good outcome. Nuss bar insertion could be a good treatment modality for traumatic flail chest in selected patients.
책임저자: 강민웅
Department of Thoracic and Cardiovascular Surgery, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
연락처 : 정유영, Tel: 042-280-7374 , E-mail : yooychong@gmail.com
