Anthony Perugini, James Iandoli, Nicholas Pelz, Daniel DeGenova, Anthony Melaragno, Mallory Faherty, Benjamin C Taylor
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引用次数: 0
Abstract
Background: Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures in a flail chest. This study aimed to analyze surgical rib fixation and assess outcomes for non-fixed fractured rib ends in segmental rib fractures.
Methods: This is a retrospective review of 125 patients who underwent open reduction internal fixation of flail segmental rib fractures at our urban Level 1 trauma center. Initial plain films and CT were compared with follow-up plain film imaging at 3 months to assess radiographic outcomes, fracture healing, fixation failure, or residual deformity. Clinical outcomes such as length of intensive care unit (ICU) stay, length of ventilatory support, associated pneumonia, duration until chest tube removal, and need for additional rib surgery were analyzed.
Results: Fixation of a single end of segmental rib fractures and flail segments was associated with decreased incidence of fracture union at 3 months postoperatively (43/55 vs 65/70, respectively; p=0.018) but failed to show any difference in fracture collapse (50/55 vs 67/70, respectively; p=0.223). There were no differences between postoperative ICU length of stay (4.18±5.54 vs 4.62±4.48 days, respectively; p=0.690), postoperative ventilatory status (29/55 vs 38/70, respectively; p=0.840), duration of ventilatory support (3.52±4.69 vs 4.34±5.87, respectively; p=0.430), or associated pneumonia (7/55 vs 8/70, respectively; p=0.770).
Conclusions: These data support that fixation of both sides of flail segment rib fractures results in improved rib fracture union at 3 months postoperatively. However, fixation of both sides of flail segments does not appear to result in any difference in fracture collapse or clinical perioperative outcomes.
背景：钝性胸椎创伤后的节段性肋骨骨折具有较高的发病率和死亡率，并伴有肺损伤和伴发损伤。关于连枷胸中一节或两节肋骨骨折的固定必要性的文献很少。本研究旨在分析手术肋骨固定并评估节段性肋骨骨折中未固定的肋骨末端骨折的结果。方法：回顾性分析125例在我市一级创伤中心接受开放复位内固定治疗连枷节段性肋骨骨折的患者。在3个月时比较初始平片和CT平片成像，以评估影像学结果、骨折愈合、固定失败或残余畸形。临床结果，如重症监护病房（ICU）住院时间、呼吸支持时间、相关肺炎、胸管拔除前持续时间和需要额外的肋骨手术进行了分析。结果：单端固定节段性肋骨骨折和连枷骨折与术后3个月骨折愈合发生率降低相关(分别为43/55 vs 65/70；P =0.018)，但在骨折塌陷方面没有任何差异(分别为50/55 vs 67/70；p = 0.223)。两组患者术后ICU住院时间（分别为4.18±5.54天和4.62±4.48天）无差异；P =0.690)，术后通气状态(分别为29/55 vs 38/70；P =0.840)、呼吸支持时间（3.52±4.69 vs 4.34±5.87）；P =0.430)或相关肺炎(分别为7/55 vs 8/70；p = 0.770)。结论：这些数据支持双侧连枷节段肋骨骨折固定可改善术后3个月肋骨骨折愈合。然而，两侧连枷节段的固定似乎不会导致骨折塌陷或临床围手术期结果的任何差异。证据等级：治疗性III级。
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