Expert consensus on diagnosis and treatment of rib, sternum, and lung trauma (version 2022)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

The Trauma Surgery Group of Thoracic Surgeons Branch of Chinese Medical Association , Thoracic Surgery Professional Committee of Chinese Research Hospital Association , Thoracic Surgery Professional Committee of Chinese Medical Education Association , Thoracic Trauma Group of Trauma Medicine Branch of Zhejiang Medical Association , Thoracic Surgery Branch of Zhejiang Medical Association , Thoracic Surgeons Branch of Zhejiang Medical Association

Corresponding author：

Keywords：

Sternum; rib; lung trauma; expert consensus

DOI：

10.7507/1007-4848.202211023

Video：

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In order to further improve the treatment level of rib, sternum, and lung trauma in China, and to provide patients with a comprehensive, safe, scientific, and standardized treatment model, we convened a meeting of outstanding thoracic surgery experts in the field of trauma in China to demonstrate and solicit opinions widely, and in accordance with the principle of evidence-based medicine, based on the best published Chinese and English evidence, finally formulated this consensus. This consensus aims to solve the possible problems in the treatment of lung, rib, and sternum trauma to the greatest extent, and provide scientific and standard clinical solutions for the treatment of thoracic surgery trauma.

Citation： The Trauma Surgery Group of Thoracic Surgeons Branch of Chinese Medical Association, Thoracic Surgery Professional Committee of Chinese Research Hospital Association, Thoracic Surgery Professional Committee of Chinese Medical Education Association, Thoracic Trauma Group of Trauma Medicine Branch of Zhejiang Medical Association, Thoracic Surgery Branch of Zhejiang Medical Association, Thoracic Surgeons Branch of Zhejiang Medical Association. Expert consensus on diagnosis and treatment of rib, sternum, and lung trauma (version 2022). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 1-9. doi: 10.7507/1007-4848.202211023 Copy

1.	Simon BJ, Cushman J, Barraco R, et al. Pain management guidelines for blunt thoracic trauma. J Trauma, 2005, 59(5): 1256-1267.
2.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3.	Cardillo G, Carbone L, Carleo F, et al. Tracheal lacerations after endotracheal intubation: A proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg, 2010, 37(3): 581-587.
4.	Thoongsuwan N, Kanne JP, Stern EJ. Spectrum of blunt chest injuries. J Thorac Imaging, 2005, 20(2): 89-97.
5.	De Wever W, Bogaert J, Verschakelen J. Radiology of lung trauma. JBR-BTR, 2000, 83(4): 167-73.
6.	Cho SH, Sung YM, Kim MS. Missed rib fractures on evaluation of initial chest CT for trauma patients: Pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT. Br J Radiol, 2012, 85(1018): e845-e850.
7.	Bentley TP, Ponnarasu S, Journey JD,Chief editor. Sternal fracture. StatPearls. Treasure Island (FL): StatPearls Publishing, 2021. 1-7.
8.	Feng G, Shi H, Wang R. The performance of multi-slice spiral CT in pulmonary laceration and its application valueJ. Med Imag Proc Tech, 2018, 1(1): 7.
9.	Faure A, Floccard B, Pilleul F, et al. Multiplanar reconstruction: A new method for the diagnosis of tracheobronchial rupture? Intensive Care Med, 2007, 33(12): 2173-2178.
10.	王健男, 王恺铖, 黄海东, 等. 气管支气管损伤的诊治现状及展望. 中国呼吸与危重监护杂志, 2021, 20(3): 219-223.
11.	张武平, 王春风, 王琳, 等. 人工智能辅助在提高CT肋骨骨折检出率作用分析. 影像研究与医学应用, 2020, 4(13): 217-218.
12.	余景武, 沈国鑫. 多层螺旋CT与磁共振成像在细微及隐匿性骨折诊断中的应用. 实用医学影像杂志, 2011, 12(1): 33-35.
13.	Gray ND, Miller K, Brath L, et al. Tracheal ring herniation. J Bronchology Interv Pulmonol, 2010, 17(1): 54-55.
14.	Koletsis E, Prokakis C, Baltayiannis N, et al. Surgical decision making in tracheobronchial injuries on the basis of clinical evidences and the injury's anatomical setting: A retrospective analysis. Injury, 2012, 43(9): 1437-1441.
15.	Hosseini M, Ghelichkhani P, Baikpour M, et al. Diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion: A systematic review and meta-analysis. Emerg (Tehran), 2015, 3(4): 127-136.
16.	Talbot BS, Gange CP Jr, Chaturvedi A, et al. Traumatic rib injury: Patterns, imaging pitfalls, complications, and treatment. Radiographics, 2017, 37(2): 628-651.
17.	Lahham S, Patane J, Lane N. Ultrasound of sternal fracture. West J Emerg Med, 2015, 16(7): 1057-1058.
18.	Bagga B, Kumar A, Chahal A, et al. Traumatic airway injuries: Role of imaging. Curr Probl Diagn Radiol, 2020, 49(1): 48-53.
19.	Turk F, Kurt AB, Saglam S. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol, 2010, 17(6): 473-477.
20.	Parry NG, Moffat B, Vogt K. Blunt thoracic trauma: Recent advances and outstanding questions. Curr Opin Crit Care, 2015, 21(6): 544-548.
21.	Blanco R, Parras T, McDonnell JG, et al. Serratus plane block: A novel ultrasound-guided thoracic wall nerve block. Anaesthesia, 2013, 68(11): 1107-1113.
22.	Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg, 2012, 73(5 Suppl 4): S351-S361.
23.	May L, Hillermann C, Patil S. Rib fracture management. Bja Education, 2016, 16(1): 26-32.
24.	Majercik S, Pieracci FM. Chest wall trauma. Thorac Surg Clin, 2017, 27(2): 113-121.
25.	Nishiumi N, Nakagawa T, Masuda R, et al. Endobronchial bleeding associated with blunt chest trauma treated by bronchial occlusion with a Univent. Ann Thorac Surg, 2008, 85(1): 245-250.
26.	Prokakis C, Koletsis EN, Dedeilias P, et al. Airway trauma: A review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg, 2014, 9: 117.
27.	Mussi A, Ambrogi MC, Ribechini A, et al. Acute major airway injuries: Clinical features and management. Eur J Cardiothorac Surg, 2001, 20(1): 46-52.
28.	Trinkle JK, Furman RW, Hinshaw MA, et al. Pulmonary contusion. Pathogenesis and effect of various resuscitative measures. Ann Thorac Surg, 1973, 16(6): 568-573.
29.	Shackford SR, Virgilio RW, Peters RM. Selective use of ventilator therapy in flail chest injury. J Thorac Cardiovasc Surg, 1981, 81(2): 194-201.
30.	Senekjian L, Nirula R. Rib fracture fixation: Indications ad outcomes. Crit Care Clin, 2017, 33(1): 153-165.
31.	Welter S. Repair of tracheobronchial injuries. Thorac Surg Clin, 2014, 24(1): 41-50.
32.	Cohn SM, Dubose JJ. Pulmonary contusion: An update on recent advances in clinical management. World J Surg, 2010, 34(8): 1959-1970.
33.	Nishiumi N, Inokuchi S, Oiwa K, et al. Diagnosis and treatment of deep pulmonary laceration with intrathoracic hemorrhage from blunt trauma. Ann Thorac Surg, 2010, 89(1): 232-238.
34.	ATLS Subcommittee. Advanced trauma life support (ATLS®): The ninth edition. J Trauma Acute Care Surg, 2013, 74(5): 1363-1366.
35.	Mowery NT, Gunter OL, Collier BR, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma, 2011, 70(2): 510-518.
36.	孙居仙, 徐志飞. 肋骨骨折治疗选择及疗效评价. 创伤外科杂志, 2009, 11(3): 275-277.
37.	刘青, 王波. 记忆金属胸部护板与传统固定方法治疗多发肋骨骨折的比较. 中国组织工程研究与临床康复, 2010, 14(17): 3197-3200.
38.	Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924-932.
39.	Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732.
40.	Granetzny AM, Abd El-Aal M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg, 2005, 4(6): 583-587.
41.	Leinicke JA, Elmore L, Freeman BD, et al. Operative management of rib fractures in the setting of flail chest: A systematic review and meta-analysis. Ann Surg, 2013, 258(6): 914-921.
42.	Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs nonoperative management of flail chest: A meta-analysis. J Am Coll Surg, 2013, 216(2): 302-311.
43.	Cataneo AJ, Cataneo DC, de Oliveira FH, et al. Surgical versus nonsurgical interventions for flail chest. Cochrane Database Syst Rev, 2015, (7): CD009919.
44.	Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: A systematic review and meta-analysis. Injury, 2012, 43(1): 8-17.
45.	Fitzgerald MT, Ashley DW, Abukhdeir H, et al. Rib fracture fixation in the 65 years and older population: A paradigm shift in management strategy at a level Ⅰ trauma center. J Trauma Acute Care Surg, 2017, 82(3): 524-527.
46.	He Z, Zhang D, Xiao H, et al. The ideal methods for the management of rib fractures. J Thorac Dis, 2019, 11(Suppl 8): S1078-S1089.
47.	Pieracci FM, Majercik S, Ali-Osman F, et al. Consensus statement: Surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury, 2017, 48(2): 307-321.
48.	Deja M, Menk M, Heidenhain C, et al. Strategies for diagnosis and treatment of iatrogenic tracheal ruptures. Minerva Anestesiol, 2011, 77(12): 1155-1166.
49.	Grewal HS, Dangayach NS, Ahmad U, et al. Treatment of tracheobronchial injuries: A contemporary review. Chest, 2019, 155(3): 595-604.
50.	Dogrul BN, Kiliccalan I, Asci ES, et al. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol, 2020, 23(3): 125-138.
51.	Su YH, Yang SM, Huang CH, et al. Early versus late surgical stabilization of severe rib fractures in patients with respiratory failure: A retrospective study. PLoS One, 2019, 14(4): e0216170.
52.	Fokin AA, Hus N, Wycech J, et al. Surgical Stabilization of rib fractures: Indications, techniques, and pitfalls. JBJS Essent Surg Tech, 2020, 10(2): e0032.
53.	沈昆, 陈瑞. 气管支气管损伤的诊断及治疗. 中国现代药物应用, 2014, 8(5): 2.
54.	明波, 晏明全, 梁青松, 等. 胸部气管、支气管损伤的诊治. 四川医学, 2005, 26(10): 2.
55.	Barmada H, Gibbons JR. Tracheobronchial injury in blunt and penetrating chest trauma. Chest, 1994, 106(1): 74-78.
56.	史宏灿, 徐洪. 气管, 支气管损伤的诊疗现状与进展. 创伤外科杂志, 2006, 8(5): 3.
57.	Zhou X, Zhang D, Xie Z, et al. 3D printing and thoracoscopy assisted MIPO in treatment of long-range comminuted rib fractures, a case report. J Cardiothorac Surg, 2019, 24(1): 83.
58.	Nirula R, Mayberry JC. Rib fracture fixation: Controversies and technical challenges. Am Surg, 2010, 76(8): 793-802.
59.	Klei DS, de Jong MB, Öner FC, et al. Current treatment and outcomes of traumatic sternal fractures-a systematic review. Int Orthop, 2019, 43(6): 1455-1464, 1469.
60.	李谦平, 成少飞, 赵永红, 等. 创伤性胸骨骨折的外科治疗. 创伤外科杂志, 2014, 16(2): 113-115.
61.	Harston A, Roberts C. Fixation of sternal fractures: A systematic review. J Trauma, 2011, 71(6): 1875-1879.
62.	Fawzy H, Alhodaib N, Mazer CD, et al. Sternal plating for primary and secondary sternal closure; can it improve sternal stability? J Cardiothorac Surg, 2009, 4: 19.
63.	Schulz-Drost S, Oppel P, Grupp S, et al. Surgical fixation of sternal fractures: Preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling. J Vis Exp, 2015, (95): e52124.
64.	Fraser SF, Tan C, Kuppusamy MK, et al. The role of a video-assisted thoracic approach for rib fixation. Eur J Trauma Emerg Surg, 2017, 43(2): 185-190.
65.	Smith JW, Franklin GA, Harbrecht BG, et al. Early VATS for blunt chest trauma: A management technique underutilized by acute care surgeons. J Trauma, 2011, 71(1): 102-105.
66.	Schots JP, Vissers YL, Hulsewé KW, et al. Addition of video-assisted thoracoscopic surgery to the treatment of flail chest. Ann Thorac Surg, 2017, 103(3): 940-944.
67.	Chou YP, Lin HL, Wu TC. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Curr Opin Pulm Med, 2015, 21(4): 393-398.
68.	Truitt MS, Murry J, Amos J, et al. Continuous intercostal nerve blockade for rib fractures: Ready for primetime? J Trauma, 2011, 71(6): 1548-1552.
69.	Pieracci FM. Completely thoracoscopic surgical stabilization of rib fractures: Can it be done and is it worth it? J Thorac Dis, 2019, 11(Suppl 8): S1061-S1069.
70.	Chen YY, Lin KH, Huang HK, et al. The beneficial application of preoperative 3D printing for surgical stabilization of rib fractures. PLoS One, 2018, 13(10): e0204652.
71.	宋磊, 张强, 宁少南, 等. 3D打印在肋骨骨折内固定中的应用. 中华胸心血管外科杂志, 2018, 34(5): 288-291.
72.	韩志锋, 苏宜江, 李坤生, 等. 快速康复外科在肋骨骨折手术中的应用. 中国胸心血管外科临床杂志, 2014, 21(1): 21-24.
73.	Booth K, Rivet J, Flici R, et al. Progressive mobility protocol reduces venous thromboembolism rate in trauma intensive care patients: A quality improvement project. J Trauma Nurs, 2016, 23(5): 284-289.

1. Simon BJ, Cushman J, Barraco R, et al. Pain management guidelines for blunt thoracic trauma. J Trauma, 2005, 59(5): 1256-1267.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. Cardillo G, Carbone L, Carleo F, et al. Tracheal lacerations after endotracheal intubation: A proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg, 2010, 37(3): 581-587.
4. Thoongsuwan N, Kanne JP, Stern EJ. Spectrum of blunt chest injuries. J Thorac Imaging, 2005, 20(2): 89-97.
5. De Wever W, Bogaert J, Verschakelen J. Radiology of lung trauma. JBR-BTR, 2000, 83(4): 167-73.
6. Cho SH, Sung YM, Kim MS. Missed rib fractures on evaluation of initial chest CT for trauma patients: Pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT. Br J Radiol, 2012, 85(1018): e845-e850.
7. Bentley TP, Ponnarasu S, Journey JD,Chief editor. Sternal fracture. StatPearls. Treasure Island (FL): StatPearls Publishing, 2021. 1-7.
8. Feng G, Shi H, Wang R. The performance of multi-slice spiral CT in pulmonary laceration and its application valueJ. Med Imag Proc Tech, 2018, 1(1): 7.
9. Faure A, Floccard B, Pilleul F, et al. Multiplanar reconstruction: A new method for the diagnosis of tracheobronchial rupture? Intensive Care Med, 2007, 33(12): 2173-2178.
10. 王健男, 王恺铖, 黄海东, 等. 气管支气管损伤的诊治现状及展望. 中国呼吸与危重监护杂志, 2021, 20(3): 219-223.
11. 张武平, 王春风, 王琳, 等. 人工智能辅助在提高CT肋骨骨折检出率作用分析. 影像研究与医学应用, 2020, 4(13): 217-218.
12. 余景武, 沈国鑫. 多层螺旋CT与磁共振成像在细微及隐匿性骨折诊断中的应用. 实用医学影像杂志, 2011, 12(1): 33-35.
13. Gray ND, Miller K, Brath L, et al. Tracheal ring herniation. J Bronchology Interv Pulmonol, 2010, 17(1): 54-55.
14. Koletsis E, Prokakis C, Baltayiannis N, et al. Surgical decision making in tracheobronchial injuries on the basis of clinical evidences and the injury's anatomical setting: A retrospective analysis. Injury, 2012, 43(9): 1437-1441.
15. Hosseini M, Ghelichkhani P, Baikpour M, et al. Diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion: A systematic review and meta-analysis. Emerg (Tehran), 2015, 3(4): 127-136.
16. Talbot BS, Gange CP Jr, Chaturvedi A, et al. Traumatic rib injury: Patterns, imaging pitfalls, complications, and treatment. Radiographics, 2017, 37(2): 628-651.
17. Lahham S, Patane J, Lane N. Ultrasound of sternal fracture. West J Emerg Med, 2015, 16(7): 1057-1058.
18. Bagga B, Kumar A, Chahal A, et al. Traumatic airway injuries: Role of imaging. Curr Probl Diagn Radiol, 2020, 49(1): 48-53.
19. Turk F, Kurt AB, Saglam S. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol, 2010, 17(6): 473-477.
20. Parry NG, Moffat B, Vogt K. Blunt thoracic trauma: Recent advances and outstanding questions. Curr Opin Crit Care, 2015, 21(6): 544-548.
21. Blanco R, Parras T, McDonnell JG, et al. Serratus plane block: A novel ultrasound-guided thoracic wall nerve block. Anaesthesia, 2013, 68(11): 1107-1113.
22. Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg, 2012, 73(5 Suppl 4): S351-S361.
23. May L, Hillermann C, Patil S. Rib fracture management. Bja Education, 2016, 16(1): 26-32.
24. Majercik S, Pieracci FM. Chest wall trauma. Thorac Surg Clin, 2017, 27(2): 113-121.
25. Nishiumi N, Nakagawa T, Masuda R, et al. Endobronchial bleeding associated with blunt chest trauma treated by bronchial occlusion with a Univent. Ann Thorac Surg, 2008, 85(1): 245-250.
26. Prokakis C, Koletsis EN, Dedeilias P, et al. Airway trauma: A review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg, 2014, 9: 117.
27. Mussi A, Ambrogi MC, Ribechini A, et al. Acute major airway injuries: Clinical features and management. Eur J Cardiothorac Surg, 2001, 20(1): 46-52.
28. Trinkle JK, Furman RW, Hinshaw MA, et al. Pulmonary contusion. Pathogenesis and effect of various resuscitative measures. Ann Thorac Surg, 1973, 16(6): 568-573.
29. Shackford SR, Virgilio RW, Peters RM. Selective use of ventilator therapy in flail chest injury. J Thorac Cardiovasc Surg, 1981, 81(2): 194-201.
30. Senekjian L, Nirula R. Rib fracture fixation: Indications ad outcomes. Crit Care Clin, 2017, 33(1): 153-165.
31. Welter S. Repair of tracheobronchial injuries. Thorac Surg Clin, 2014, 24(1): 41-50.
32. Cohn SM, Dubose JJ. Pulmonary contusion: An update on recent advances in clinical management. World J Surg, 2010, 34(8): 1959-1970.
33. Nishiumi N, Inokuchi S, Oiwa K, et al. Diagnosis and treatment of deep pulmonary laceration with intrathoracic hemorrhage from blunt trauma. Ann Thorac Surg, 2010, 89(1): 232-238.
34. ATLS Subcommittee. Advanced trauma life support (ATLS®): The ninth edition. J Trauma Acute Care Surg, 2013, 74(5): 1363-1366.
35. Mowery NT, Gunter OL, Collier BR, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma, 2011, 70(2): 510-518.
36. 孙居仙, 徐志飞. 肋骨骨折治疗选择及疗效评价. 创伤外科杂志, 2009, 11(3): 275-277.
37. 刘青, 王波. 记忆金属胸部护板与传统固定方法治疗多发肋骨骨折的比较. 中国组织工程研究与临床康复, 2010, 14(17): 3197-3200.
38. Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg, 2013, 216(5): 924-932.
39. Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma, 2002, 52(4): 727-732.
40. Granetzny AM, Abd El-Aal M, Emam E, et al. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact Cardiovasc Thorac Surg, 2005, 4(6): 583-587.
41. Leinicke JA, Elmore L, Freeman BD, et al. Operative management of rib fractures in the setting of flail chest: A systematic review and meta-analysis. Ann Surg, 2013, 258(6): 914-921.
42. Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs nonoperative management of flail chest: A meta-analysis. J Am Coll Surg, 2013, 216(2): 302-311.
43. Cataneo AJ, Cataneo DC, de Oliveira FH, et al. Surgical versus nonsurgical interventions for flail chest. Cochrane Database Syst Rev, 2015, (7): CD009919.
44. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: A systematic review and meta-analysis. Injury, 2012, 43(1): 8-17.
45. Fitzgerald MT, Ashley DW, Abukhdeir H, et al. Rib fracture fixation in the 65 years and older population: A paradigm shift in management strategy at a level Ⅰ trauma center. J Trauma Acute Care Surg, 2017, 82(3): 524-527.
46. He Z, Zhang D, Xiao H, et al. The ideal methods for the management of rib fractures. J Thorac Dis, 2019, 11(Suppl 8): S1078-S1089.
47. Pieracci FM, Majercik S, Ali-Osman F, et al. Consensus statement: Surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury, 2017, 48(2): 307-321.
48. Deja M, Menk M, Heidenhain C, et al. Strategies for diagnosis and treatment of iatrogenic tracheal ruptures. Minerva Anestesiol, 2011, 77(12): 1155-1166.
49. Grewal HS, Dangayach NS, Ahmad U, et al. Treatment of tracheobronchial injuries: A contemporary review. Chest, 2019, 155(3): 595-604.
50. Dogrul BN, Kiliccalan I, Asci ES, et al. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol, 2020, 23(3): 125-138.
51. Su YH, Yang SM, Huang CH, et al. Early versus late surgical stabilization of severe rib fractures in patients with respiratory failure: A retrospective study. PLoS One, 2019, 14(4): e0216170.
52. Fokin AA, Hus N, Wycech J, et al. Surgical Stabilization of rib fractures: Indications, techniques, and pitfalls. JBJS Essent Surg Tech, 2020, 10(2): e0032.
53. 沈昆, 陈瑞. 气管支气管损伤的诊断及治疗. 中国现代药物应用, 2014, 8(5): 2.
54. 明波, 晏明全, 梁青松, 等. 胸部气管、支气管损伤的诊治. 四川医学, 2005, 26(10): 2.
55. Barmada H, Gibbons JR. Tracheobronchial injury in blunt and penetrating chest trauma. Chest, 1994, 106(1): 74-78.
56. 史宏灿, 徐洪. 气管, 支气管损伤的诊疗现状与进展. 创伤外科杂志, 2006, 8(5): 3.
57. Zhou X, Zhang D, Xie Z, et al. 3D printing and thoracoscopy assisted MIPO in treatment of long-range comminuted rib fractures, a case report. J Cardiothorac Surg, 2019, 24(1): 83.
58. Nirula R, Mayberry JC. Rib fracture fixation: Controversies and technical challenges. Am Surg, 2010, 76(8): 793-802.
59. Klei DS, de Jong MB, Öner FC, et al. Current treatment and outcomes of traumatic sternal fractures-a systematic review. Int Orthop, 2019, 43(6): 1455-1464, 1469.
60. 李谦平, 成少飞, 赵永红, 等. 创伤性胸骨骨折的外科治疗. 创伤外科杂志, 2014, 16(2): 113-115.
61. Harston A, Roberts C. Fixation of sternal fractures: A systematic review. J Trauma, 2011, 71(6): 1875-1879.
62. Fawzy H, Alhodaib N, Mazer CD, et al. Sternal plating for primary and secondary sternal closure; can it improve sternal stability? J Cardiothorac Surg, 2009, 4: 19.
63. Schulz-Drost S, Oppel P, Grupp S, et al. Surgical fixation of sternal fractures: Preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling. J Vis Exp, 2015, (95): e52124.
64. Fraser SF, Tan C, Kuppusamy MK, et al. The role of a video-assisted thoracic approach for rib fixation. Eur J Trauma Emerg Surg, 2017, 43(2): 185-190.
65. Smith JW, Franklin GA, Harbrecht BG, et al. Early VATS for blunt chest trauma: A management technique underutilized by acute care surgeons. J Trauma, 2011, 71(1): 102-105.
66. Schots JP, Vissers YL, Hulsewé KW, et al. Addition of video-assisted thoracoscopic surgery to the treatment of flail chest. Ann Thorac Surg, 2017, 103(3): 940-944.
67. Chou YP, Lin HL, Wu TC. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Curr Opin Pulm Med, 2015, 21(4): 393-398.
68. Truitt MS, Murry J, Amos J, et al. Continuous intercostal nerve blockade for rib fractures: Ready for primetime? J Trauma, 2011, 71(6): 1548-1552.
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