符合肋骨骨折手术稳定标准的患者与实际获得肋骨固定的患者的比较：单中心回顾

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2024-10-03 DOI:10.1016/j.injury.2024.111930

Zachary M. Bauman , Hason Khan , Jakob Phillips , Alyssa Wells , Charity H. Evans , John L. Liu , Andrew Kamien , Samuel Cemaj , Olabisi Sheppard , Gina Lamb , Jessica Veatch , Jonathan Nguyen , Mike Matos , Emily Cantrell

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引用次数: 0

摘要

背景：肋骨骨折手术稳定（SSRF）对肋骨骨折患者有明显的益处。然而，SSRF 的实施率仍然很低。我们将本院符合 SSRF 标准的肋骨骨折患者与实际接受手术的患者进行了比较，假设有很大一部分患者没有接受 SSRF：方法：对2016年1月1日至2023年4月4日期间在我院一级创伤中心就诊的肋骨骨折患者进行回顾性分析。根据2023年胸壁损伤协会（CWIS）SSRF指南，将患者分为符合SSRF纳入标准和不符合SSRF纳入标准的两类。获得了基本的人口统计数据。符合 SSRF 标准的患者分为接受 SSRF 和未接受 SSRF 的患者。相关结果包括 SSRF 适应症的类型和频率，以及绝对/相对禁忌症的频率。采用描述性统计。统计分析采用中位数检验和 t 检验。统计显著性以 p < 0.05 为标准：共有 3432 名患者出现≥1 根肋骨骨折。其中 1,573 人（45.8%）符合 SSRF 纳入标准。这些患者主要为男性，平均年龄为 57.4（±18.5）岁，损伤严重程度评分相似，但胸部简易损伤评分显著高于 3（四分位间范围 3,4）（p = 0.048）。只有 458 名（29.1%）患者接受了 SSRF，剩下的 1,115 名（70.9%）患者接受了非手术治疗，其中 215 名（19.3%）接受了呼吸机治疗，"未能脱离呼吸机 "是 SSRF 最常见的适应症（81.4%）。在接受非手术治疗的 900 名（80.7%）非通气患者中，659 名（69.9%）有≥两个 SSRF 适应症，382 名（34.3%）没有相对禁忌症，394 名（35.3%）有一个 SSRF 相对禁忌症。最后，52.6%的患者报告其骨折处有 "咔哒/咔哒 "声：结论：根据本机构的数据，只有 29.1% 的符合 SSRF 标准的患者接受了手术。这部分符合 SSRF 标准但未接受手术的患者可能还有机会从中获益。

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Comparison of patients who meet criteria for surgical stabilization of rib fractures versus those who actually get rib fixation: A single center review

Background

Surgical stabilization of rib fractures (SSRF) has shown benefits for rib fracture patients. However, the incidence of SSRF performed remains low. We compare our institution's rib fracture patients meeting criteria for SSRF versus those actually receiving the operation, hypothesizing a significant portion are not undergoing SSRF.

Methods

A retrospective review of rib fracture patients presenting to our Level 1 trauma center from 1/2016 to 4/2023. Patients were categorized as those who met SSRF inclusion criteria versus those who didn't based on the 2023 Chest Wall Injury Society (CWIS) SSRF Guidelines. Basic demographics were obtained. Patients meeting SSRF criteria were divided into those who received SSRF versus those who didn't. Outcomes of interest included type and frequency of SSRF indications and frequency of absolute/relative contraindications. Descriptive statistics were used. Median test and t-test were used for statistical analysis. Statistical significance was set at p < 0.05.

Results

A total of 3,432 patients presented with ≥1 rib fracture(s). Of those, 1,573(45.8 %) met SSRF inclusion criteria. These patients were predominantly male, with mean age of 57.4(±18.5) and a similar Injury Severity Score but significantly higher chest-Abbreviated Injury Score of 3 (Interquartile range 3,4)(p = 0.048). Only 458(29.1 %) patients underwent SSRF, leaving 1,115(70.9 %) managed non-operatively, of which 215(19.3 %) were ventilated and “failure to wean from the ventilator” was the most common (81.4 %) indication for SSRF. Of the 900(80.7 %) non-ventilated patients managed non-operatively, 659 (69.9 %) had ≥two indications for SSRF, 382(34.3 %) had zero relative contraindications and 394(35.3 %) had one relative contraindication for SSRF. Lastly, 52.6 % of patients in this cohort had reported “clicking/popping” of their fractures.

Conclusion

Only 29.1 % of patients meeting criteria for SSRF had the operation based on data from our institution. There may be additional opportunity to benefit this cohort of patients meeting SSRF criteria but not undergoing surgery.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.