Complete uni-port video-assisted thoracoscopic surgery for surgical stabilization of rib fractures: a case report

A 53-year-old man accidentally fell off a three-meter high scaffolding while working resulting in severe chest pain and shortness of breath. Upon arrival at the emergency department of our hospital, physical examination was the following: temperature, 36.8 ℃; blood pressure, 132/86 mmHg; heart rate,101 beats/min; oxygen saturation, 89% (without oxygen inhalation), left chest tenderness, pain on anteroposteria chest compression. Taken chest computed tomography (CT) (Fig. 1), he was found with left 7th through 11th rib fractures with lower left lobe contusion and hemothorax measured about 10% of the chest. After treatment with oxygen, external fixation by band, and pain management, the symptoms were initially relieved, while the pain remained severe several hours later even after the use of pethidine. After consultation, he decided to undergo surgery.

Fig. 1figure 1

As the left 7th and 8th anterior ribs and the 10th and 11th posterior ribs were dislocated, the patient was taken to the operating room. After the double lumen endotracheal intubation general anesthesia, the patient was placed in the right decubitus position. After skin preparation and draping, a 4 cm incision was made in the 7th intercostal space near the anterior axillary line, where a membrane incision expander was put in, and thoracoscopes and operating instruments operated through the port. Exploration revealed minor active bleeding in the parietal pleura around the fracture, after suction and electrocoagulation, hematoma and deformity were found in the 7th and 8th anterior rib, as well as 10th and 11th ribs, the bone friction sensation around the rib fracture line was evident when pressed. Special instruments were needed (Fig. 2). The rib coaptation boards with 4 or 8 arms (manufactured by Lanzhou Seemine Shape Memory Alloy Co., Ltd, China) were used to fix the fractures. The implantation tool with detachable tong head (manufactured by Lanzhou Seemine Shape Memory Alloy Co., Ltd, China,) was used to connect the rib coaptation board and placed it to the broken ribs. An oval bending forcep (manufactured by Lanzhou Seemine Shape Memory Alloy Co., Ltd, China) was used to reduce displacements. After exposing fractures with an electrocoagulation hook burning, reduction was implement with forcep (for the 10th and 11th rib) or fingers (for the 7th and 8th rib). Loosened the arms of boards under 0℃ ice sterile saline, connected the boards and implantation tool, delivered boards to fractures, and inserted four embracing arms into the upper and lower edges of the fractured rib. After prayed 50℃ sterile saline, boards return to previous shape to clasp and fix the fractured rib. As the result, the rib fractures are stable without screws or wires (Fig. 3). A drainage tube was placed from the incision, and the procedure end up with incision suturing layer by layer (Fig. 4).

Fig. 2figure 2Fig. 3figure 3Fig. 4figure 4

The incision and fractures location

Postoperatively, the patient was transferred to the ward for vital signs detection, oxygen inhalation, atomization, pain relief, hemostasis, and fluid therapy. On the post-operative day (POD) 1, he expressed his satisfaction at the apparent ease of the pain, and reexamination of chest CT showed that the fracture was well fixed (Fig. 5). On the POD 2, since the fluid was only 50 ml, the drainage tube was removed, and the patient was discharged next day. A month later, the pain had entirely resolved. The follow-up examination showed the fracture healing well, and the patient returned to work.

Fig. 5figure 5

Reexamination of chest CT

留言 (0)

沒有登入
gif