Lu Ming-Shian, Huang Yao-Kuang, Liu Yun-Hen, Liu Hui-Ping, Kao Chiung-Lun
Division of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Putz City, Chiayi County, Taiwan.
Am J Emerg Med. 2008 Jun;26(5):551-4. doi: 10.1016/j.ajem.2007.08.022.
Pneumothorax (PTX) after trauma is a preventable cause of death. Drainage procedures such as chest tube insertion have been traditionally advocated to prevent fatal tension PTX. We evaluated the safety of close observation in patients with delayed PTX complicating rib fracture after minor chest trauma.
Adult patients (>18 years) with a diagnosis of chest trauma and 3 or fewer fractured ribs were reviewed. Case patients were divided according to age, location and number of fractured ribs, mechanism of trauma, and initial pulmonary complication after thoracic trauma for comparative analysis.
There were 207 male (70.2%) and 88 female (29.8%) patients whose ages ranged from 18 to 93 years (median, 55 years). The mechanisms of trauma were a motor vehicle accident in 207 patients, falls in 66, pedestrian injury in 10, and assaults in 14. Ninety-five patients sustained 1 rib fracture, 95 had 2 rib fractures, and 105 suffered 3 rib fractures. Right-sided injury occurred in 164 cases, left-sided injury did in 127, and bilateral injury did in 4. The most frequent location of rib fractures was from the fourth rib to the ninth rib. The initial pulmonary complications after trauma were PTX in 16 patients, hemothorax in 43, pneumohemothorax in 14, lung contusion in 75, and isolated subcutaneous emphysema (SubcEmph) in 33. Thirty percent of the patients (n = 5/16) who presented with traumatic PTX were observed safely without drainage. Delayed PTX was recorded in 16 patients, occurring mostly during the first 2 days of their admission. Associated extrathoracic injury was recorded in 189 patients. The mean hospital stay of the patients was 7.66 days. Longer hospital stay was related to increasing number of fractured ribs, need for thoracic drainage, and the presence of associated extrathoracic injury. The mortality rate for the entire group was 2%. The presence of SubcEmph was the only risk factor associated with the development of delayed PTX.
Patients sustaining blunt chest trauma and minor rib fractures should be admitted for close observation when presenting with SubcEmph because of possible delayed presentation of PTX.
创伤后气胸（PTX）是一种可预防的死亡原因。传统上主张采用胸腔闭式引流等引流程序来预防致命性张力性PTX。我们评估了在轻度胸部创伤后并发肋骨骨折的延迟性PTX患者中密切观察的安全性。
回顾性分析诊断为胸部创伤且肋骨骨折3根及以下的成年患者（>18岁）。根据年龄、肋骨骨折的部位和数量、创伤机制以及胸部创伤后的初始肺部并发症对病例患者进行分组，以进行对比分析。
共有207例男性患者（70.2%）和88例女性患者（29.8%），年龄范围为18至93岁（中位数为55岁）。创伤机制包括机动车事故207例、跌倒66例、行人损伤10例和袭击14例。95例患者发生1根肋骨骨折，95例发生2根肋骨骨折，105例发生3根肋骨骨折。右侧损伤164例，左侧损伤127例，双侧损伤4例。肋骨骨折最常见的部位是第4肋骨至第9肋骨。创伤后的初始肺部并发症包括气胸16例、血胸43例、血气胸14例、肺挫伤75例和单纯皮下气肿（SubcEmph）33例。30%（n = 5/16）出现创伤性PTX的患者在未行引流的情况下得到了安全观察。16例患者记录有延迟性PTX，大多发生在入院后的头2天。189例患者记录有相关的胸外损伤。患者的平均住院时间为7.66天。住院时间延长与肋骨骨折数量增加、需要胸腔引流以及存在相关胸外损伤有关。整个组的死亡率为2%。SubcEmph的存在是与延迟性PTX发生相关的唯一危险因素。
因可能出现延迟性PTX，钝性胸部创伤和轻度肋骨骨折患者出现SubcEmph时应入院密切观察。
