Lazcano A, Dougherty J M, Kruger M
Department of Emergency Medicine, Akron General Medical Center, OH 44307.
Am J Emerg Med. 1989 Jan;7(1):97-100. doi: 10.1016/0735-6757(89)90093-4.
The current treatment for uncomplicated rib fractures is the exclusion of associated injuries followed by symptomatic treatment with analgesics. Encouragement of deep breathing is also recommended to avoid secondary or delayed pulmonary complications. The use of circumferential rib belts in treating patients with acute rib fractures has been discouraged because of possible complications from restricted ventilation. A review of the literature revealed no previous clinical studies to support this view. We designed and conducted a controlled, prospective, randomized pilot study to determine if there was any increased morbidity associated with the use of rib belts in the treatment of patients with acute rib fractures. Twenty-five adult patients with radiographically proven acute rib fractures were randomized into two groups. The first group was treated with analgesics and a standard circumferential rib belt (Zimmer Universal Rib Belt). The second group was treated with oral analgesics alone. Patients were contacted by telephone three days after the initial injury and then reexamined 14 days postinjury. Rates of pain resolution, compliance, and delayed complications were determined. Rib belts were not found to significantly reduce the severity of pain. Four complications (one case of bloody pleural effusion requiring hospitalization, two cases of asymptomatic discoid atelectasis, and one case of allergic contact dermatitis) were identified, all occurring in the group of patients receiving rib belts. This pilot study indicates that while rib belts are widely accepted by patients for control of pain, they appear to be associated with an increased incidence of complications. Clinical studies with larger sample sizes will be needed to confirm these findings.
目前对于单纯性肋骨骨折的治疗方法是排除相关损伤，然后使用镇痛药进行对症治疗。还建议鼓励深呼吸以避免继发性或延迟性肺部并发症。由于可能因通气受限而引发并发症，不提倡使用环形肋骨带治疗急性肋骨骨折患者。对文献的回顾显示，此前尚无临床研究支持这一观点。我们设计并开展了一项对照、前瞻性、随机试验性研究，以确定在治疗急性肋骨骨折患者时使用肋骨带是否会增加发病率。25例经影像学证实为急性肋骨骨折的成年患者被随机分为两组。第一组采用镇痛药和标准环形肋骨带（齐默通用肋骨带）治疗。第二组仅采用口服镇痛药治疗。在初次受伤三天后通过电话联系患者，然后在受伤14天后再次进行检查。确定疼痛缓解率、依从性和延迟并发症发生率。结果发现肋骨带并不能显著减轻疼痛程度。共发现4例并发症（1例血性胸腔积液需住院治疗，2例无症状盘状肺不张，1例过敏性接触性皮炎），均发生在接受肋骨带治疗的患者组中。这项试验性研究表明，虽然肋骨带被患者广泛接受用于控制疼痛，但它们似乎与并发症发生率的增加有关。需要开展更大样本量的临床研究来证实这些发现。
