An avid cyclist was out riding with a friend when, trying to evade a small animal that suddenly appeared out of nowhere, he was thrown from his bike. He sustained a broken leg and broken ribs, and air became trapped in his pleural cavity (the space between the chest wall and the lung). He was sent to the emergency room at the Hsinchu branch of National Taiwan University Hospital. One month later the man returned for a follow-up treatment, and told the doctors how happy he was to be able to be riding again.
According to Tu Hsiung, a doctor at the Hsinchu branch, broken ribs due to external trauma to the chest are seen frequently in the trauma clinic at the emergency room. They are often seen in senior citizens who have fallen over, people involved in bicycle accidents or those who have fallen from a height in the workplace.
In humans, the thorax is formed of the collarbone, 12 pairs of ribs to the left and right, and the breastbone and thoracic vertebrae. The ribs form a cage surrounding the chest, protecting important organs including the heart and lungs, as well as the liver to the lower right of the diaphragm and the spleen to the lower left. The ability to breathe depends upon the movement of the ribs, through the contraction of the diaphragm and the respiratory muscles.
Photo: Tsai Chang-sheng, Liberty Times
記者蔡彰盛翻攝
When somebody has an accident, the first clear symptom of the patient having sustained broken ribs is localized pain. In serious cases, broken ribs can be life threatening, for example when it leads to tension pneumothorax or a hemothorax (air or blood trapped in the pleural cavity, respectively) and difficulty breathing. Acute, life-threatening complications can arise when pain makes it difficult to breathe or cough up phlegm, leading to pneumonia and eventually septic shock (blood poisoning).
The treatment for broken ribs begins with stopping the pain, to ensure that the patient feels comfortable. Efficient respiration is important if pneumonia is to be prevented. If the pain is not stopped, the patient will not want to breathe deeply, and the breathing will gradually become shallower, reducing the amount they will be able to cough. Eventually, this could lead to the development of pneumonia.
With improvements in medical treatments and increasing focus on patients’ quality of life, doctors have developed the surgical stabilization of rib fractures. The main objectives of this technique are to reduce the amount of pain the patient with broken ribs is in, to prevent the emergence of complications and to reduce the chance of mortality and the length of stay in hospital. This will help the patient to recover more quickly and to be able to return to work.
According to clinical statistics, the surgical stabilization of rib fractures procedure can significantly lower the chances of the patient developing pneumonia, reduce the treatment period and length of hospital stay by half and even cut the mortality rate by 30 percent.
(Translated by Paul Cooper)
熱愛自行車運動的一位男子某次休假與車友快樂騎乘時，為了閃躲突然衝出的小動物，不慎摔車飛了出去，腿部與肋骨骨折、胸部張力性氣胸，轉送台大醫院新竹分院急診。術後一個月回診，患者開心地跟醫師分享重拾自行車的騎乘樂趣。
台大醫院新竹分院急診部醫師杜雄表示，胸部外傷致肋骨骨折是外傷急診常見的疾病。常見於高齡長者在日常生活中跌倒、車禍或是工地高處跌落的傷者。
人體胸廓由鎖骨、左右兩邊十二對肋骨、胸骨與胸椎所組成。肋骨在胸部組成一個環狀，保護著重要器官包含心臟、肺和橫隔膜下右側的肝及左側的脾臟。身體靠著橫隔膜和呼吸肌收縮牽動肋骨，才能呼吸。
當發生意外，肋骨骨折的第一個明顯症狀就是肋骨折斷處疼痛。嚴重的肋骨骨折可能會立即危及生命，例如導致張力性氣胸、大量出血的血胸、因無法有效呼吸；慢性致死原因則有因為疼痛不敢或無法有效呼吸、咳痰，以致引發肺炎敗血症，或因連枷胸導致呼吸衰竭等。
肋骨骨折治療首重止痛，讓病人感覺舒適，有效呼吸才能預防肺炎。如果止痛沒有做好，病人會因為疼痛而不敢深呼吸，呼吸深度就會慢慢變淺，伴隨咳嗽力度減低，最終變成肺炎。
隨著醫療的進步與生活品質的要求提升，肋骨骨折固定接合手術應運而生。肋骨骨折固定接合手術的最大目的，就是要減低肋骨骨折病人的疼痛，避免併發症發生、減低死亡率、縮短住院日數，以利早日恢復正常生活和回到工作崗位。
臨床統計，有做肋骨骨折固定接合手術的病人，可以大幅減少肺炎發生率達九成，縮短一半加護病房照顧和住院日數，甚至可以減少三成的死亡率。
（自由時報記者蔡彰盛）
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