de Moya Marc, Bramos Thanos, Agarwal Suresh, Fikry Karim, Janjua Sumbal, King David R, Alam Hasan B, Velmahos George C, Burke Peter, Tobler William
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
J Trauma. 2011 Dec;71(6):1750-4. doi: 10.1097/TA.0b013e31823c85e9.
In trauma patients, open reduction and internal fixation of rib fractures remain controversial. We hypothesized that patients who have open reduction and internal fixation of rib fractures would experience less pain compared with controls and thus require fewer opiates. Further, we hypothesized that improved pain control would result in fewer pulmonary complications and decreased length of stay.
This is a retrospective bi-institutional matched case-control study. Cases were matched 1:2 by age, injury severity Score, chest abbreviated injury severity score, head abbreviated injury severity score, pulmonary contusion score, and number of fractured ribs. The daily total doses of analgesic drugs were converted to equianalgesic intravenous morphine doses, and the primary outcome was inpatient narcotic administration.
Sixteen patients between July 2005 and June 2009 underwent rib fixation in 5 ± 3 days after injury using an average of 3 (1-5) metallic plates. Morphine requirements decreased from 110 mg ± 98 mg preoperatively to 63 ± 57 mg postoperatively (p = 0.01). There were no significant differences between cases and controls in the mean morphine dose (79 ± 63 vs. 76 ± 55 mg, p = 0.65), hospital stay (18 ± 12 vs. 16 ± 11 days, p = 0.67), intensive care unit stay (9 ± 8 vs. 7 ± 10 days, p = 0.75), ventilation days (7 ± 8 vs. 6 ± 10, p = 0.44), and pneumonia rates (31% vs. 38%, p = 0.76).
The need for analgesia was significantly reduced after rib fixation in patients with multiple rib fractures. However, no difference in outcomes was observed when these patients were compared with matched controls in this pilot study. Further study is required to investigate these preliminary findings.
在创伤患者中，肋骨骨折的切开复位内固定术仍存在争议。我们假设，与对照组相比，接受肋骨骨折切开复位内固定术的患者疼痛较轻，因此所需的阿片类药物较少。此外，我们假设更好的疼痛控制将导致更少的肺部并发症和缩短住院时间。
这是一项回顾性双机构配对病例对照研究。病例按年龄、损伤严重程度评分、胸部简明损伤严重程度评分、头部简明损伤严重程度评分、肺挫伤评分和肋骨骨折数量1:2配对。将每日镇痛药总剂量换算为等效镇痛静脉吗啡剂量，主要结局为住院期间的麻醉剂使用情况。
2005年7月至2009年6月期间，16例患者在受伤后5±3天接受肋骨固定，平均使用3（1 - 5）块金属板。吗啡需求量从术前的110 mg±98 mg降至术后的63±57 mg（p = 0.01）。病例组和对照组在平均吗啡剂量（79±63 vs. 76±55 mg，p = 0.65）、住院时间（18±12 vs. 16±11天，p = 0.67）、重症监护病房停留时间（9±8 vs. 7±10天，p = 0.75）、通气天数（7±8 vs. 6±10，p = 0.44）和肺炎发生率（31% vs. 38%，p = 0.76）方面无显著差异。
多根肋骨骨折患者肋骨固定后镇痛需求显著降低。然而，在这项初步研究中，将这些患者与配对对照组进行比较时，未观察到结局有差异。需要进一步研究来调查这些初步发现。
