Abstract：
BACKGROUND Nonunion of a rib fracture can cause chronic pain, and pharmacological pain management may lead to medication dependence. This report describes a 54-year-old man with a chronic cough and painful nonunion fracture of the left posterior 8th rib, managed with minimally invasive surgery and a rib splint. CASE REPORT A 54-year-old man presented with chronic cough-induced left chest wall pain. Three-dimensional chest computed tomography (CT) scan showed a nonunion of a fracture of the left posterior 8th rib. After medical management failure, we proposed a surgical approach with the aim to remove the tissue comprising the nonunion, release the nerve, and stabilize the bone stumps. To avoid the adverse effects of a large incision, we designed a minimally invasive strategy based on ultrasound fracture localization and the use of an intramedullary splint. The pain disappeared immediately after surgery. The patient was discharged in 24 hours. At 6-week follow-up, he was still asymptomatic, and a new CT scan reconfirmed the correct splint position. From the immediate postoperative evaluation until the last follow-up visit, he consistently reported full satisfaction. CONCLUSIONS This report has highlighted the challenges of management of chronic pain in nonunion of a rib fracture, and has described the use of a minimally invasive surgical approach. In this single case, our tailored surgical strategy achieved definitive success in pain management, minimizing postoperative complications/adverse effects and avoiding the addition of pain medications despite a 24-hour hospital stay. Our goal is to share an alternative solution for colleagues facing similar cases.
摘要：
背景技术肋骨骨折不愈合可引起慢性疼痛,和药理学疼痛管理可能导致药物依赖。这份报告描述了一名54岁的男性，患有慢性咳嗽和疼痛的左后8根骨不愈合骨折，用微创手术和肋骨夹板管理。病例报告一名54岁男子出现慢性咳嗽诱发的左胸壁疼痛。三维胸部计算机断层扫描（CT）扫描显示左后8肋骨骨折不愈合。医疗管理失败后，我们提出了一种手术方法，目的是去除骨不连的组织，释放神经，稳定骨桩.为了避免大切口的不利影响，我们设计了一种基于超声骨折定位和使用髓内夹板的微创策略.手术后疼痛立即消失。患者24小时后出院。在6周的随访中，他仍然没有症状，和新的CT扫描再次确认正确的夹板位置。从术后立即评估到最后一次随访，他一直表示完全满意。结论本报告强调了治疗肋骨骨折不愈合的慢性疼痛的挑战，并描述了微创手术方法的使用。在这种情况下，我们量身定制的手术策略在疼痛管理方面取得了决定性的成功，尽管住院24小时，但仍可最大限度地减少术后并发症/不良反应，并避免添加止痛药。我们的目标是为面临类似情况的同事分享另一种解决方案。
