背景:急性胸锁后部关节损伤是罕见的,但可能是致命的损伤—纵隔压迫的征象范围从非特异性到神经血管损害。目前,骨科专家建议,在开放手术期间,心胸外科医生应待命,以防止潜在的术中并发症。然而,很少有研究报道需要心胸外科干预的频率。
方法:首先,从2002年1月1日至2023年5月1日,我们通过CPT编码23530,23525和23532在我们机构中确定了患者.收集人口统计学变量和术中心胸干预率。第二,我们系统地回顾了文献,以确定使用PubMed,Embase,和CINAHL数据库(至2023年8月20日)。排除标准包括保守治疗,成功的封闭还原,慢性损伤(>6周)尸体研究,reviews,和不可用的文本。
结果:13例局部患者因急性胸锁关节后部损伤接受了开放手术,男11例,女2例,平均年龄18.2岁(范围:15至32.4)。最常见的损伤机制是运动(n=9;69.2%)。四名(30.8%)患者有纵隔压迫的身体或影像学证据。我们机构没有患者需要术中心胸干预。文献检索产生了132篇文章和512例急性胸锁关节后部损伤的开放性手术。四名患者需要术中心胸干预,所有患者均出现多发性创伤和/或神经血管损害的临床或影像学征象,综合总体率为0.76%。
结论:专家意见通常建议在急性胸锁关节后部损伤的开放手术期间进行心胸备份。根据我们的本地数据和系统的文献综述,我们发现整体心胸介入率为0.76%.在多发性创伤和/或神经血管受损的发现下,我们建议在手术过程中密切待命进行心胸外科手术。然而,患有孤立性急性胸锁后关节损伤且无神经血管损害的临床或影像学表现的患者似乎不需要心胸外科医生待命。最终,在对患者进行全面的身体和影像学评估后,应根据具体情况决定在急性胸锁后部损伤的开放手术期间进行心胸备份。
方法:三级。
BACKGROUND: Acute posterior sternoclavicular joint injuries are rare but potentially lethal injuries-signs of mediastinal compression range from nonspecific to neurovascular compromise. Currently, orthopaedic experts recommend a cardiothoracic surgeon be placed on standby during open surgery for potential intraoperative complications. However, few studies have reported on how often cardiothoracic intervention is required.
METHODS: First, we identified patients in our institution by CPT codes 23530, 23525, and 23532 from January 1, 2002 to May 1, 2023. Demographic variables and intraoperative cardiothoracic intervention rates were collected. Second, we systematically reviewed the literature to identify articles on acute posterior sternoclavicular injury using PubMed, Embase, and CINAHL databases (through August 20, 2023). Exclusion criteria included conservative treatment, successful closed reduction, chronic injury (>6 wk) cadaver studies, reviews, and nonavailable text.
RESULTS: Thirteen local patients underwent open surgery for an acute posterior sternoclavicular joint injury, 11 males and 2 females with an average age of 18.2 years old (range: 15 to 32.4). The most common mechanism of injury was sports (n=9; 69.2%). Four (30.8%) patients had physical or radiographic evidence of mediastinal compression. No patients required intraoperative cardiothoracic intervention in our institution. The literature search yielded 132 articles and 512 open surgeries for acute posterior sternoclavicular joint injuries. Four patients required intraoperative cardiothoracic intervention, all of whom presented with polytrauma and/or clinical or radiographic signs of neurovascular compromise, giving a combined overall rate of 0.76%.
CONCLUSIONS: Expert opinion commonly recommends cardiothoracic backup during open surgery for acute posterior sternoclavicular joint injuries. On the basis of our local data and systematic literature review, we found an overall cardiothoracic intervention rate of 0.76%. In the presence of polytrauma and/or findings of neurovascular compromise, we suggest having cardiothoracic surgery on close standby during the procedure. However, a patient with an isolated acute posterior sternoclavicular joint injury and no clinical or radiographic findings of neurovascular compromise does not appear to require a cardiothoracic surgeon on standby. Ultimately, the decision to involve cardiothoracic backup during open surgery for an acute posterior sternoclavicular injury should be made on a case-by-case basis after a thorough physical and radiographic evaluation of the patient.
METHODS: Level III.