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Emergency Department, Barnes Hospital, St. Louis, Mo. 63110.
Am J Emerg Med. 1990 Jul;8(4):277-81. doi: 10.1016/0735-6757(90)90073-9.
The authors present a pilot study in which 20 patients with simple rib fractures were randomized prospectively into two treatment groups. One group received ibuprofen and the other group ibuprofen plus a rib belt for analgesia. There were no statistically significant differences observed in pulmonary function testing between the groups at initial visit, 48 hours, or 5 days. Atelectasis developed in four patients, two in each treatment group; there were no cases of pneumonitis. Patients with displaced rib fractures experienced a higher rate of hemo- or pneumothorax than did those with nondisplaced fractures (5/10 v 1/10). Patients with displaced fractures who used rib belts experienced a higher rate of hemothorax than those using oral analgesia alone (4/6 v 1/4). Patients using rib belts uniformly reported a significant amount of additional pain relief. The clinician can use a rib belt to provide additional comfort to the patient with fractured ribs without apparent additional compromise to respiratory parameters. A further study stratifying displaced and nondisplaced fractures has been initiated to clarify the possible contributing roles of displaced rib fractures and the rib belt in patients with displaced fractures.
作者开展了一项试点研究，将20例单纯肋骨骨折患者前瞻性随机分为两个治疗组。一组接受布洛芬治疗，另一组接受布洛芬加肋骨固定带镇痛治疗。在初次就诊、48小时或5天时，两组间肺功能测试结果无统计学显著差异。4例患者发生肺不张，每个治疗组各2例；无肺炎病例。移位肋骨骨折患者发生血胸或气胸的比例高于未移位骨折患者（5/10比1/10）。使用肋骨固定带的移位骨折患者发生血胸的比例高于仅使用口服镇痛药的患者（4/6比1/4）。使用肋骨固定带的患者均报告疼痛明显减轻。临床医生可以使用肋骨固定带给肋骨骨折患者提供额外的舒适感，而不会明显影响呼吸参数。已启动一项进一步的研究，对移位和未移位骨折进行分层，以阐明移位肋骨骨折和肋骨固定带在移位骨折患者中可能的作用。
