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多发性肋骨骨折,手术治疗还是保守治疗哪种更好?

Which is better to multiple rib fractures, surgical treatment or conservative treatment?

作者信息

Wu Wei-Ming, Yang Yi, Gao Zong-Li, Zhao Tian-Cheng, He Wei-Wei

机构信息

Deparment of Thoracic Surgery, Shanghai Jiao Tong Universtity Affiliated Sixth People's Hospital Shanghai, China.

出版信息

Int J Clin Exp Med. 2015 May 15;8(5):7930-6. eCollection 2015.

Abstract

To compare the surgery and conservative treatment of multiple fractured ribs, we designed a randomized controlled trial in the single center of thoracic surgery ward. After admission condition assessment (general clinical evaluation, operation condition assessment, the digital method of pain assessment), the selected multiple fractured rib patients were told to choose surgery or conservative treatment, according to the patient will undergo surgery or conservative treatment. In the acute phase, compared with conservative treatment, patients with mechanical ventilation in time (mechanical ventilation time MV) (3.7 ± 1.4 vs. 9.5 ± 4.3), ICU stay time (8.2 ± 4.3 vs. 14.6 ± 3.2), total hospitalization days (15.3 ± 6.4 vs. 26.5 ± 6.9), the incidence of pneumonia (6.7% vs. 19.1%), mortality (1.3% vs. 5.3%) and pain score on patients (3.3 vs. 5.8) of surgical treatment group were significant lower (P < 0.05). The number of tracheostomy in surgical patients with conservative treatment (4 vs. 7) was no statistically significant difference (P > 0.05). In chronic phase, the surgical patients compared with patients with conservative treatment in the chest wall pain (2.9 ± 1.2 vs. 5.6 ± 1.7), chest wall tension (13.3% vs. 57.3%), dyspnea (5.3% vs. 22.4%) and chest wall deformity rate (4% vs. 93.5%) were lower significantly (P < 0.05). In conclusion, the surgical treatment of multiple fractured ribs could ease the acute chest pain, reduce the mechanical ventilation time and incidence of pneumonia, shorten the hospitalization days and total hospitalization days in the ICU and alleviate the forward chest wall discomfort. The speedy recovery and long-term quality of patients' life had improved significantly.

摘要

为比较多根肋骨骨折的手术治疗与保守治疗效果,我们在胸外科病房单中心设计了一项随机对照试验。入选的多根肋骨骨折患者在入院条件评估(一般临床评估、手术条件评估、疼痛数字评估法)后,根据患者意愿选择手术或保守治疗。急性期,与保守治疗相比,手术治疗组患者的机械通气时间(MV)(3.7±1.4天对9.5±4.3天)、ICU住院时间(8.2±4.3天对14.6±3.2天)、总住院天数(15.3±6.4天对26.5±6.9天)、肺炎发生率(6.7%对19.1%)、死亡率(1.3%对5.3%)及疼痛评分(3.3对5.8)均显著降低(P<0.05)。手术患者与保守治疗患者的气管切开例数(4例对7例)差异无统计学意义(P>0.05)。慢性期,手术患者与保守治疗患者相比,胸壁疼痛(2.9±1.2对5.6±1.7)、胸壁张力(13.3%对57.3%)、呼吸困难(5.3%对22.4%)及胸壁畸形率(4%对93.5%)均显著降低(P<0.05)。总之,多根肋骨骨折的手术治疗可缓解急性胸痛,减少机械通气时间和肺炎发生率,缩短ICU住院天数和总住院天数,减轻前胸壁不适。患者的快速康复及长期生活质量得到显著改善。

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