Bhattacharya Bishwajit, Fieber Jennifer, Schuster Kevin, Davis Kimberly, Maung Adrian
Department of Surgery, Yale School of Medicine, Connecticut, USA.
J Emerg Trauma Shock. 2015 Jul-Sep;8(3):140-3. doi: 10.4103/0974-2700.160706.
Prior to the widespread use of computed tomography (CT) scan imaging, lower rib fractures diagnosed on chest X-rays (CXRs) were considered a risk factor for abdominal solid organ injury (ASOI). However, CXRs miss about 50% of the rib fractures that are detected on CT scans. We hypothesized that these "occult" rib fractures would not be predictive for ASOI.
Retrospective review of a level I trauma center's database identified all adult blunt trauma patients (n = 11,170) over a 5-year period. Data were abstracted for demographics, injury severity score, presence of ASOI, extremity, pelvic and spine fractures as well as presence and location of rib fractures.
Rib fractures correlated with the presence of ASOI, regardless of whether they were diagnosed by CXR or CT scan alone (P < 0.01). Middle (3-7) and lower (8-12) rib fractures, especially, correlated with the presence of ipsilateral ASOI (P < 0.0001).
Although CT scan detects more rib fractures than CXR, rib fractures remain a marker for increased likelihood of ASOI regardless of the modality by which they are diagnosed. Patients with rib fractures also have a greater incidence of spine and pelvic fractures. As the trauma community debates moving away from routine whole-body CT imaging towards a more selective approach, these results suggest that any clinical suspicion of rib fractures, despite a negative CXR, may warrant further investigation.
在计算机断层扫描（CT）成像广泛应用之前，胸部X线（CXR）诊断出的下肋骨骨折被认为是腹部实性器官损伤（ASOI）的危险因素。然而，CXR会漏诊约50%在CT扫描中检测到的肋骨骨折。我们推测这些“隐匿性”肋骨骨折不能预测ASOI。
对一家一级创伤中心数据库进行回顾性分析，确定了5年内所有成年钝性创伤患者（n = 11,170）。提取了人口统计学、损伤严重程度评分、ASOI的存在情况、四肢、骨盆和脊柱骨折情况以及肋骨骨折的存在和位置等数据。
肋骨骨折与ASOI的存在相关，无论其是仅通过CXR还是CT扫描诊断（P < 0.01）。尤其是中（3 - 7）段和下（8 - 12）段肋骨骨折与同侧ASOI的存在相关（P < 0.0001）。
尽管CT扫描比CXR能检测到更多肋骨骨折，但无论诊断方式如何，肋骨骨折仍然是ASOI可能性增加的一个标志。肋骨骨折患者脊柱和骨盆骨折的发生率也更高。随着创伤学界讨论从常规全身CT成像转向更具选择性的方法，这些结果表明，尽管CXR结果为阴性，但任何对肋骨骨折的临床怀疑都可能需要进一步检查。
