TORAKS TRAVMASI: 532 OLGUNUN ANALÝZÝ

Trafik kazalarý, 40 yaþ altý eriþkinlerde kaza sonucunda meydana gelen ölümlerin baþlýca nedenlerindendir. Bu ölümlerin azaltýlabilmesi çok basit önlemlerle olasýdýr. Yöntem: A.Ü.T.F. Göðüs Cerrahisi A.B.D'nda Ocak 1988 ve Þubat 1998 arasýnda künt ve penetran göðüs travmalý 532 hasta deðerlendirildi. Hastalarýn 4087 erkek 124'ü kadýndý. Künt travmalý 448 hastanýn 128'inde kosta fraktürü, 93'ünde kosta fraktürü ve pnömotoraks, 32'inde kosta fraktürü ve hemotoraks, 94'ünde kosta fraktürü ve hemopnömotoraks, 44'ünde yelken göðüs, 48'inde sternum fraktürü, sekizinde diafragma rüptürü ve bir hastada da özofagus rüptürü vardý. Penetran travmalý 84 hastanýn 18'inde pnömotoraks, 12'sinde hemotoraks, 29'unda hemopnömotoraks, üçünde diafragma rüptürü, yedisinde büyük damar yaralanmasý, bir hastada sol atrium ve yine bir hastada özofagus-trakea ve larinks yaralanmasý söz konusuyken 13 hasta asemptomatikti. Sonuçlar: Tedavi sonuçlarý kosta fraktürü, kosta fraktürü ile pnömotoraks ve hemotoraks olan hastalarda baþarýlýydý. Bu grupta morbidite ve mortalite gözlenmedi. Hemopnömotoraksý olan 123 hastanýn, 18'i gözlemde tutuldu, 91'ine göðüs tüpü konuldu (Göðüs tüpü konulmasýnýn ardýndan 26 hasta ameliyata alýndý), sekiz hasta ise doðrudan operasyona alýndý. Bu grupta mortalite oraný %5.69 (7/123)'du. Yelken göðüslü hastalarýn 41'inde mekanik ventilasyon gerekti ve 11 hasta SIRS, karaciðer ve böbrek yetmezliðinden kaybedildi. Sternum fraktürlü olgularýn yalnýzca dokuzuna cerrahi fiksasyon gerekti. Tüm diafragma yaralanmalarý primer onarýldý. Toraks travmalarýnda, doðru taný ve uygun cerrahi yaklaþým bu tür yaralanmalarda morbidite ve mortalitenin azaltýlmasýnýn temelini oluþturur.

THORACIC TRAUMA: ANALYSIS OF 532 PATIENTS

Traffic vehicle accidents are the main causes of accidental death under the age of40. Simple prevention can reduce these deaths. Method: We have reviewed 532 patients with blunt and penetrating chest trauma between January 1988 and February 1998. There were 408 males and 124 females. There were rib fractures in 128 patients, rib fractures with pneumothorax in 93 patients and rib fractures with hemothorax in 32 patient, rib fractures with hemopneumothorax in 94 patients, flail chest in 44 patients, sternal fractures in 48 patients, diaphragmatic ruptures in 8 patients and one esophageal rupture in 448 patients with blunt chest injuries. Penetrating injuries were present in 84 patients: 18 pneumothoraces, 12 hemothoraces, 29 hemopneumothoraces, 3 diaphragmatic ruptures, 7 major vessels injuries, one left atrium injury, one esophagus-trachea-larynx injury; 13 patients were asymptomatic. Result: The results of the treatment were generally good in rib fractures, rib fractures with pneumothorax and hemothorax. No morbidity and mortality were observed in these groups. In 123 patients with hemopneumothorax, 18 patients were hospitalized and tube thoracostomy was performed in 97patients (26patients underwent immediate thoracotomy after chest tube insertion), emergency thoracotomy was performed in 8 patients. In this group mortality rate was 5.69 % (7/123). In flail chest group, 41 patients needed mechanical ventilation support and 11 patients died were due to SIRS, hepatic and renal failure. Surgical fixation for sternal fractures was carried out in 9 patients. All diaphragmatic injuries were performed primary repair. In thoracic trauma, correct diagnostic and appropriate therapeutic approach, remain the cornerstone of treatment to minimize the morbidity and mortality of such injuries.