Kessel Boris, Dagan Jasmin, Swaid Forat, Ashkenazi Itamar, Olsha Oded, Peleg Kobi, Givon Adi, Alfici Ricardo
Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.
Am J Surg. 2014 Nov;208(5):831-834. doi: 10.1016/j.amjsurg.2013.10.033. Epub 2014 Mar 26.
Rib fractures are considered a marker of exposure to significant traumatic energy. In children, because of high elasticity of the chest wall, higher energy levels are necessary for ribs to fracture. The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures.
A retrospective cohort study involving blunt trauma patients with rib fractures registered in the National Trauma Registry was conducted.
Of 6,995 trauma victims who were found to suffer from rib fractures, 328 were children and 6,627 were adults. Isolated rib fractures without associated injuries occurred in 19 children (5.8%) and 731 adults (11%). More adults had 4 or more fractured ribs compared with children (P < .001). Children suffered from higher rates of associated brain injuries (P = .003), hemothorax/pneumothorax (P = .006), spleen, and liver injury (P < .001). Mortality rate was 5% in both groups.
The incidence of associated head, thoracic, and abdominal solid organ injuries in children was significantly higher than in adults suffering from rib fractures. In spite of a higher Injury Severity Score and incidence of associated injuries, mortality rate was similar. Mortality of rib fracture patients was mostly affected by the presence of extrathoracic injuries.
肋骨骨折被视为遭受重大创伤能量的标志。在儿童中，由于胸壁弹性较高，肋骨骨折需要更高的能量水平。本研究的目的是分析与成人相比儿童肋骨骨折相关损伤的模式，所有患者均为肋骨骨折患者。
对国家创伤登记处登记的肋骨骨折钝性创伤患者进行回顾性队列研究。
在6995名被发现患有肋骨骨折的创伤受害者中，328名是儿童，6627名是成人。19名儿童（5.8%）和731名成人（11%）发生了无相关损伤的单纯肋骨骨折。与儿童相比，更多成人有4根或更多肋骨骨折（P <.001）。儿童发生相关脑损伤（P =.003）、血胸/气胸（P =.006）、脾脏和肝脏损伤（P <.001）的发生率更高。两组的死亡率均为5%。
儿童肋骨骨折相关的头部、胸部和腹部实体器官损伤的发生率显著高于成人。尽管损伤严重程度评分较高且相关损伤发生率较高，但死亡率相似。肋骨骨折患者的死亡率主要受胸外损伤的影响。
