Department of Trauma and Orthopaedic Surgery, Ysbyty Gwynedd, UK.
Injury. 2010 May;41(5):495-8. doi: 10.1016/j.injury.2009.07.072. Epub 2009 Aug 13.
Routine admission of patients with isolated sternal fractures for observation is still widespread in the UK. However, the evidence appears to suggest that this is unnecessary. We undertook a cross-sectional telephone survey of management of isolated sternal fractures in the UK. We contacted 85 acute admitting units over a three-month period and were able to get a response from 67 units. Most of the hospitals were district general hospitals (52) and situated in England (49). The orthopaedic department was the most common admitting department. 51 units indicated that they regularly admit isolated sternal fractures for observation. Other indications for admission included pain control (33), abnormal cardiac enzymes (28), social circumstances (23), abnormal electrocardiogram (6), and low oxygen saturation (5). Chest X-ray was performed on admission in all hospitals. 57 hospitals performed ECG and cardiac enzyme tests prior to admission and 6 hospitals carried out echocardiogram following admission on a regular basis. Patients were not followed up on discharge. 2 hospitals with on-site cardiothoracic unit followed-up patients on discharge, and 1 hospital advised GP follow-up. A review of the literature indicated that patients with isolated sternal fractures are at low risk of significant cardiac, pulmonary or mediastinal complications and do not need extensive investigations or routine admission. The current practice of management of isolated sternal fractures in the UK does not appear to conform to available evidence. In order to decide on management plans based on more rigorous evidence, there is a need for a prospective double blind randomised study of patients with isolated sternal fractures, comparing those discharged to those admitted over a longer follow-up period.
在英国，常规收治单纯胸骨骨折患者进行观察的做法仍较为普遍。然而，现有证据表明这种做法并无必要。我们针对英国单纯胸骨骨折的处理方式进行了横断面电话调查。我们在三个月的时间里联系了 85 家急症收治单位，其中有 67 家单位做出了回应。这些医院大多为地区综合医院（52 家），且分布在英格兰（49 家）。收治科室以骨科为主。51 家医院表示会常规收治单纯胸骨骨折患者进行观察。收治的其他指征包括疼痛控制（33 家）、心酶异常（28 家）、社会环境（23 家）、心电图异常（6 家）和低血氧饱和度（5 家）。所有医院在入院时均进行了胸部 X 线检查。57 家医院在入院前进行了心电图和心酶检测，6 家医院常规在入院后进行了超声心动图检查。患者在出院时不进行随访。2 家设有心胸外科科室的医院会在出院时对患者进行随访，1 家医院则建议由全科医生进行随访。文献回顾表明，单纯胸骨骨折患者发生严重心脏、肺部或纵隔并发症的风险较低，无需进行广泛的检查或常规收治。英国目前对单纯胸骨骨折的处理方式似乎与现有证据不符。为了根据更严格的证据制定管理方案，需要对单纯胸骨骨折患者进行前瞻性、双盲、随机研究，比较出院患者与住院患者在更长随访期内的情况。
