扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 18. Pleura Diseases_Thoracic Trauma

Thoracic Traumatracheabronchusbronchiolesribslung(insideview)-lungrib(cutaway)diaphragm-

1 Thoracic Trauma

Thoracic SurgeryThoracic surgery is the field of medicine involved in the surgicaltreatment of diseases affecting organs inside the thorax (the chest)excluding the heart.Generally treatment of conditions of the lungs, chest wall.esophagus and diaphragmThoracic surgery is often grouped with cardiac surgery and calledcardiothoracic surgery (primarily in the United States)ed1aEsophagusLoweresophagealsphincterStomachWADAM

2 ◼ Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting organs inside the thorax (the chest) excluding the heart. ◼ Generally treatment of conditions of the lungs, chest wall, esophagus and diaphragm. ◼ Thoracic surgery is often grouped with cardiac surgery and called cardiothoracic surgery (primarily in the United States). Thoracic Surgery

Anatomy and Physiology of the ThoraxThoracic Skeleton12 Pair of C-shaped ribsRibs 1-7: Join at sternum with cartilage end-pointsRibs 8-10: Join sternum with combined cartilage at 7th ribRibs11-12:NoanteriorattachmentSternumAngle of LouisManubriumManubriumJoins to clavicle and 1st ribTrueribsBodySternum(vertebrosternalJugularNotchXiphoid.BodyprocessCostalcartilageSternal angle (Angle of Louis)JunctionofthemanubriumwithAttachment of 2nd ribVertebrochondralFalseribsXiphoidprocessribsDistalportionof sternumFloating ribs

3 Anatomy and Physiology of the Thorax ◼ Thoracic Skeleton ◼ 12 Pair of C-shaped ribs ◼ Ribs 1-7: Join at sternum with cartilage end-points ◼ Ribs 8-10: Join sternum with combined cartilage at 7th rib ◼ Ribs 11-12: No anterior attachment ◼ Sternum ◼ Manubrium ◼ Joins to clavicle and 1st rib ◼ Jugular Notch ◼ Body ◼ Sternal angle (Angle of Louis) ◼ Junction of the manubrium with the sternal body ◼ Attachment of 2nd rib ◼ Xiphoid process ◼ Distal portion of sternum

Anatomy and Physiology of the ThoraxThoracic SkeletonTopographical Thoracic Reference LinesMidclavicular lineAnterior axillary lineMid-axillarylinePosterioraxillarylineIntercostal spaceArtery,VeinandNerveoninferiormarginofeachribThoracic InletSuperioropeningofthethoraxCurvatureof1stribwithassociatedstructuresThoracic OutletInferioropeningofthethorax12th rib and associated structures & Xiphisternal joint

4 Anatomy and Physiology of the Thorax ◼ Thoracic Skeleton ◼ Topographical Thoracic Reference Lines ◼ Midclavicular line ◼ Anterior axillary line ◼ Mid-axillary line ◼ Posterior axillary line ◼ Intercostal space ◼ Artery, Vein and Nerve on inferior margin of each rib ◼ Thoracic Inlet ◼ Superior opening of the thorax ◼ Curvature of 1st rib with associated structures ◼ Thoracic Outlet ◼ Inferior opening of the thorax ◼ 12th rib and associated structures & Xiphisternal joint

Anatomy and Physiology of the ThoraxEsophagusTrachea, Bronchi & LungsTracheaTracheaLungs-HeartHollow&cartilagesupportedstructure-DiaphragmBronchiRight&leftextendfor3centimetersStomach. Enters lungs at Pulmonary HilumAlsowherepulmonaryarteries&veinsenterFurthersubdivideandterminateasalveoliBasicunitofstructure&functioninthelungsSingle cell membraneExternal versus Internal RespirationLungs Right = 3 lobesLeft = 2 lobes5

5 Anatomy and Physiology of the Thorax ◼ Trachea, Bronchi & Lungs ◼ Trachea ◼ Hollow & cartilage supported structure ◼ Bronchi ◼ Right & left extend for 3 centimeters ◼ Enters lungs at Pulmonary Hilum ◼ Also where pulmonary arteries & veins enter ◼ Further subdivide and terminate as alveoli ◼ Basic unit of structure & function in the lungs ◼ Single cell membrane ◼ External versus Internal Respiration ◼ Lungs ◼ Right = 3 lobes ◼ Left = 2 lobes

Anatomy and Physiology of the ThoraxMediastinumCentral space within thoracic cavityBoundariesLateral:LungsInferior:DiaphragmSuperior:Thoracicoutlet上级漏Structures胸骨粉Heart胸骨角GreatVessels前纸匾Esophagus中纵隔-21Trachea后纵隔下级隔NervesVagusPhrenicThoracicDuct6

6 Anatomy and Physiology of the Thorax ◼ Mediastinum ◼ Central space within thoracic cavity ◼ Boundaries ◼ Lateral: Lungs ◼ Inferior: Diaphragm ◼ Superior: Thoracic outlet ◼ Structures ◼ Heart ◼ Great Vessels ◼ Esophagus ◼ Trachea ◼ Nerves ◼ Vagus ◼ Phrenic ◼ Thoracic Duct

Thoracic Trauma Chest trauma (or thoracic trauma) is a serioussinjuryof the chest Thoracic trauma is a common cause of significantdisability and mortality, the leading cause of death fromphysical trauma after head and spinal cord injury.Blunt thoracic injuries are the primary or a contributingcause of about a quarter of all trauma-related deaths The mortality rate is about 10%

7 ◼ Chest trauma (or thoracic trauma) is a serious injury of the chest. ◼ Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury. ◼ Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths. ◼ The mortality rate is about 10%. Thoracic Trauma

ClassificationChest trauma can be classified as bluntt orpenetrating Blunt and penetrating injuries have differentpathophysiologies and clinical courses.Specific types of chest trauma include:(1)Injuries to the chest wall Chest wall contusions or hematomasRib fracturesFlail chestSternal fracturesFractures of the clavicle and sshoulder girdle8

8 Classification ◼ Chest trauma can be classified as blunt or penetrating. ◼ Blunt and penetrating injuries have different pathophysiologies and clinical courses. ◼ Specific types of chest trauma include: (1)Injuries to the chest wall ◼ Chest wall contusions or hematomas. ◼ Rib fractures ◼ Flail chest ◼ Sternal fractures ◼ Fractures of the clavicle and shoulder girdle

(2)Pulmonary injury (injury to the lung) and injuriesinvolving the pleural spacePulmonary contusionPulmonary lacerationPneumothoraxHemothoraxHemopneumothorax(3)Injury to the airwaysTracheobronchial tear9

9 (2)Pulmonary injury (injury to the lung) and injuries involving the pleural space ◼ Pulmonary contusion ◼ Pulmonary laceration ◼ Pneumothorax ◼ Hemothorax ◼ Hemopneumothorax (3)Injury to the airways ◼ Tracheobronchial tear

Most blunt injuries are managed with relatively simpleinterventions like intubation and mechanical ventilationand chest tube insertion.Diagnosis of blunt injuries may be more difficult andrequire additional investigations such as CT scanningPenetrating injuries often require surgery, and complexinvestigations are usually not needed to come to adiagnosis.10

10 ◼ Most blunt injuries are managed with relatively simple interventions like intubation and mechanical ventilation and chest tube insertion. ◼ Diagnosis of blunt injuries may be more difficult and require additional investigations such as CT scanning. ◼ Penetrating injuries often require surgery, and complex investigations are usually not needed to come to a diagnosis