Introduction

High rates of morbidity and mortality following flail chest rib fractures are well publicized. Standard of care has been supportive mechanical ventilation, but serious complications have been reported. Internal rib fixation has shown improvements in pulmonary function, clinical outcomes, and decreased mortality. The goal of this study was to provide a model defining the biomechanical benefits of internal rib fixation.

Methods

One human cadaver was prepared with an actuator providing anteroposterior forces to the thorax and rib motion sensors to define interfragmentary motion. Cadaveric model was validated using a prior study which defined costovertebral motion to create a protocol using similar technology and procedure. Ribs 4–6 were fixed with motion sensors anteriorly, laterally and posteriorly. Motion was recorded with ribs intact before osteotomizing each rib anteriorly and laterally. Flail chest motion was record with fractures subsequently plated and analyzed. Motion was recorded in the sagittal, coronal and transverse axes.

Findings

Compared to the intact rib model, the flail chest model demonstrated an 11.3 times increase in sagittal plane motion, which was reduced to 2.1 times the intact model with rib plating. Coronal and sagittal plane models also saw increases of 9.7 and 5.1 times, respectively, with regards to flail chest motion. Both were reduced to 1.2 times the intact model after rib plating.

Interpretation

This study allows quantification of altered ribcage biomechanics after flail chest injuries and suggests rib plating is useful in restoring biomechanics as well as contributing to improving pulmonary function and clinical outcomes.

中文翻译：

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肋骨骨折固定生物力学评估模型

介绍

fl骨肋骨骨折后高发病率和高死亡率已广为人知。护理标准是支持性机械通气，但有严重并发症的报道。肋骨内固定已显示肺功能，临床结局和死亡率降低。这项研究的目的是提供一个定义内部肋骨固定的生物力学益处的模型。

方法

准备了一个带有执行器的人尸体，该执行器向胸部和肋骨运动传感器提供前后力，以定义碎片间运动。使用先前的研究验证了尸体模型，该研究定义了肋椎运动以使用类似的技术和程序创建协议。肋骨4–6通过运动传感器在前面，侧面和后面固定。记录运动情况，肋骨完整无缺，然后从前方和侧面截骨。记录了连chest的胸部运动，随后对骨折进行了电镀和分析。沿矢状，冠状和横轴记录运动。

发现

与完整的肋骨模型相比，the胸模型的矢状面运动增加了11.3倍，而肋骨板的减少了至完整模型的2.1倍。就fl胸运动而言，冠状和矢状平面模型也分别增加了9.7和5.1倍。肋骨镀覆后，两者均降至完整模型的1.2倍。

解释

这项研究可以量化fl fl受伤后改变的胸腔生物力学，并建议肋板可用于恢复生物力学，并有助于改善肺功能和临床结果。