RezumatDate generale: Leziunile cu volet costal (FCI) sunt asociate cu o rată ridicată de morbiditate şi mortalitate. Având în vedere că asocierea unei fracturi de claviculă concomitente cu FCI agravează chiar rezultatul, întrebarea care se pune este cum pot fi aceste leziuni costoclaviculare (CCI) gestionate chirurgical. Metode: 11 pacienţi cu CCI au fost trataţi chirurgical prin osteosinteză a claviculei şi a coastelor subiacente prin placă blocată, prin abordări chirurgicale limitate, sub anestezie generală. Pacienţii au fost urmăriţi la 2, 6, 12, 26 şi 52 de săptămâni. Rezultate: Toţi pacienţii au prezentat o deformare severă a peretelui toracic din cauza fracturilor puternic deplasate ale coastelor şi claviculei. Ei sufereau de durere şi de restrângerea mişcărilor respiratorii. Peretele toracic a putut fi restabilit la forma normală în toate cazurile, cu vindecare lipsită de complicaţii a oaselor şi confort sporit al pacientului. Fracturile claviculei şi celei de-a doua coaste au fost gestionate printr-o abordare inovatoare clavipectorală, iar celelalte prin abordări standard ale peretelui anterolateral şi posterolateral. Doi pacienţi s-au plâns de amorţeală în zona intervenţiei laterale şi de durere periscapulară peristentă. Concluzii: Stabilizarea chirurgicală ar putea reprezenta terapia adecvată în CCI cu fracturi dislocate, deoarece acestea ar putea cauza deformări severe şi pierderea funcţiei peretelui toracic şi a umărului.
Injection laryngoplasty of materials for unilateral vocal‐fold paralysis has shown various results regarding the long‐term stability of the injected material. We evaluated a fibrin‐gel based cell suspension with autologous chondrocytes in‐vitro and in‐vivo as long‐term‐stable vocal‐fold augmentation material in an animal model.
This study compises an in vitro cell‐culture part as well as an in vivo animal study with New Zealand White Rabbits.
In in‐vitro experiments, auricular chondrocytes harvested from 24 New Zealand White Rabbits cadavers were cultivated in pellet cultures to evaluate cartilage formation for 4 weeks using long‐term‐stable fibrin gel as carrier. Injectability and injection volume for the laryngoplasty was determined in‐vitro using harvested cadaveric larynxes. In‐vivo 24 Rabbits were biopsied for elastic cartilage of the ear and autologous P1 cells were injected lateral of one vocal cord into the paraglottic space suspended in a long‐term‐stable fibrin gel. Histologic evaluation was performed after 2, 4, 12, and 24 weeks.
During 12‐week pellet culture, we found extracellular matrix formation and weight‐stable cartilage of mature appearance. In‐vivo, mature cartilage was found in two larynxes (n = 6) at 4 weeks, in four (n = 6) at 12 weeks, and in five (n = 6) at 24 weeks mostly located in the paraglottic space and sometimes with spurs into the vocalis muscle. Surrounding tissue was often infiltrated with inflammatory cells. Material tended to dislocate through the cricothyroid space into the extraglottic surrounding tissue.
A cell‐based approach with chondrocytes for permanent vocal‐fold augmentation has not previously been reported. We have achieved the formation of structurally mature cartilage in the paraglottic space, but this is accompanied by difficulties with dislocated material, deformation of the augmentation, and inflammation.
Level of Evidence
N/A Laryngoscope, 131:E1624–E1632, 2021
Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax.
A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF.
73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF.
Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.
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