胸部外伤【38页】_20221500（最新文档）.pptx

胸外伤进展;Incidenceandmortality:

Chesttraumaaccountsfor8%occurrencesoftotaltraumaticcases,morethan25%ofdeathcausedbytrauma.;胸外伤病因;Resultsfromkineticenergyforces

Blast（爆破伤）

Pressurewavecausestissuedisruption

Tearbloodvesselsdisruptalveolartissue

Disruptionoftracheobronchialtree

Traumaticdiaphragmrupture

Crush(Compression)（挤压伤）

Bodyiscompressedbetweenanobjectandahardsurface

Directinjuryofchestwallandinternalstructures

Deceleration（减速伤）

Bodyinmotionstrikesafixedobject

Blunttraumatochestwall

Internalstructurescontinueinmotion

LigamentumArteriosumshearsaorta

;

LowEnergy

Arrows,knives,handguns

Injurycausedbydirectcontactandcavitation

HighEnergy

Military,huntingrifleshighpoweredhandguns

Extensiveinjuryduetohighpressurecavitation

;穿透伤合并损伤;Tracheobronchialtreelacerations

Esophageallacerations

Penetratingcardiacinjuries

Pericardialtamponade

Spinalcordinjuries

Diaphragmtrauma

Intra-abdominalpenetrationwithassociatedorganinjury;;

;;RibFractures

50%ofsignificantchesttraumacasesduetoblunttrauma

Compressionalforcesflexandfractureribsatweakestpoints

Ribs1-3requiresgreatforcetofracture

Possibleunderlyinglunginjury

Ribs4-9aremostcommonlyfractured

Ribs9-12lesslikelytobefractured

Transmitenergyoftraumatointernalorgans

Iffractured,suspectliverandspleeninjury

HypoventilationisCOMMONduetoPAIN;SternalFractureDislocation

（胸骨骨折和错位）

Associatedwithseverebluntanteriortrauma

DirectBlow(比如：方向盘)

Incidence:5-8%

Mortality:25-45%

Myocardialcontusion

Pericardialtamponade

Cardiacrupture

Pulmonarycontusion

DislocationuncommonbutsameMOIasfracture

Trachealdepressionifposterior

;FlailChest(连枷胸)

Segmentofthechestthatbecomesfreetomovewiththepressurechangesofrespiration

Threeormoreadjacentribfractureintwoormoreplaces

Seriouschestwallinjurywithunderlyingpulmonaryinjury