Al-Hassani Ammar, Abdulrahman Husham, Afifi Ibrahim, Almadani Ammar, Al-Den Ahmed, Al-Kuwari Abdulaziz, Recicar John, Nabir Syed, Maull Kimball I
Section of Trauma Surgery, Department of Surgery, Hamad General Hospital Doha, Qatar.
Am Surg. 2010 Aug;76(8):888-91.
Blunt trauma patients with rib fractures were studied to determine whether the number of rib fractures or their patterns were more predictive of abdominal solid organ injury and/or other thoracic trauma. Rib fractures were characterized as upper zone (ribs 1 to 4), midzone (ribs 5 to 8), and lower zone (ribs 9 to 12). Findings of sternal and scapular fractures, pulmonary contusions, and solid organ injures (liver, spleen, kidney) were characterized by the total number and predominant zone of ribs fractured. There were 296 men and 14 women. There were 38 patients with scapular fracture and 19 patients with sternal fractures. There were 90 patients with 116 solid organ injuries: liver (n = 42), kidney (n = 27), and spleen (n = 47). Lower rib fractures, whether zone-limited or overlapping, were highly predictive of solid organ injury when compared with upper and midzones. Scapular and sternal fractures were more common with upper zone fractures and pulmonary contusions increased with the number of fractured ribs. Multiple rib fractures involving the lower ribs have a high association with solid organ injury, 51 per cent in this series. The increasing number of rib fractures enhanced the likelihood of other chest wall and pulmonary injuries but did not affect the incidence of solid organ injury.
对肋骨骨折的钝性创伤患者进行了研究，以确定肋骨骨折的数量或其模式是否更能预测腹部实体器官损伤和/或其他胸部创伤。肋骨骨折分为上区（第1至4肋）、中区（第5至8肋）和下区（第9至12肋）。胸骨和肩胛骨骨折、肺挫伤以及实体器官损伤（肝、脾、肾）的情况根据肋骨骨折的总数和主要区域进行描述。研究对象包括296名男性和14名女性。有38例肩胛骨骨折患者和19例胸骨骨折患者。有90例患者发生了116处实体器官损伤：肝脏（42例）、肾脏（27例）和脾脏（47例）。与上区和中区相比，下肋骨骨折，无论是否局限于某一区域或存在重叠，都高度提示实体器官损伤。肩胛骨和胸骨骨折在上区骨折中更为常见，肺挫伤随肋骨骨折数量的增加而增多。累及下肋骨的多根肋骨骨折与实体器官损伤密切相关，本系列研究中这一比例为51%。肋骨骨折数量的增加增加了其他胸壁和肺部损伤的可能性，但不影响实体器官损伤的发生率。
