Muhm M, Härter J, Weiss C, Winkler H
Department of Trauma and Orthopaedic Surgery, Westpfalz-Klinikum Kaiserslautern, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany.
Department of Trauma and Orthopaedic Surgery, Medical Faculty Mannheim, Heidelberg University and Mainz University, Heidelberg, Germany.
Eur J Trauma Emerg Surg. 2013 Jun;39(3):257-65. doi: 10.1007/s00068-013-0262-x. Epub 2013 Feb 16.
Serial rib fractures and flail chest injury can be treated by positive-pressure ventilation. Operative techniques reduce intensive care unit (ICU) stay, overall costs, mortality and morbidity, as well as pain. The aim of this study was to evaluate the benefit of surgical rib stabilisation in comparison to non-operative treatment in patients with severe trauma of the chest wall.
From 2006 to 2011, the data of 44 patients with flail chest and serial rib fractures were collected retrospectively. A surgical group and an intensive care group with only intensive care therapy were formed. Rib and sternal fractures, flail chest, injury severity, thoracic injuries, mechanical ventilation, time in the ICU, overall hospital stay and mortality were evaluated.
No postoperative surgical complications had been observed. The time under mechanical ventilation in the surgical group was 10.6 ± 10.2 days, whereas in the non-surgical group, it was 13.7 ± 13.7 days. Mechanical ventilation time after surgery was 6.9 ± 6.5 days. Time in the ICU for the surgical group was 16.4 ± 13.6 days, compared to the non-surgical group with 20.1 ± 16.2 days. Postoperative time in the ICU was 11.7 ± 10.3 days. The mortality in the surgical group was 10 % and in the non-surgical group it was 17 %.
Operative rib stabilisation with plates is a safe therapy option for severe trauma of the chest wall. Provided that the duration of preoperative mechanical ventilation and time spent in the ICU is minimised due to early operation, our data suggest that the stabilisation of serial rib fractures and flail chest may lead to a reduced time of mechanical ventilation, time in the ICU and mortality.
连枷胸损伤及多发性肋骨骨折可通过正压通气进行治疗。手术技术可缩短重症监护病房（ICU）住院时间、降低总体费用、死亡率及发病率，并减轻疼痛。本研究旨在评估手术肋骨固定术相较于非手术治疗对胸壁严重创伤患者的益处。
回顾性收集2006年至2011年44例连枷胸及多发性肋骨骨折患者的数据。分为手术组和仅接受重症监护治疗的重症监护组。评估肋骨及胸骨骨折、连枷胸、损伤严重程度、胸部损伤、机械通气、ICU住院时间、总体住院时间及死亡率。
未观察到术后手术并发症。手术组机械通气时间为10.6±10.2天，而非手术组为13.7±13.7天。术后机械通气时间为6.9±6.5天。手术组ICU住院时间为16.4±13.6天，非手术组为20.1±16.2天。术后ICU住院时间为11.7±10.3天。手术组死亡率为10%，非手术组为17%。
钢板手术肋骨固定术是治疗胸壁严重创伤的一种安全治疗选择。鉴于早期手术可将术前机械通气时间及ICU住院时间降至最低，我们的数据表明，多发性肋骨骨折及连枷胸的固定可能会缩短机械通气时间、ICU住院时间并降低死亡率。
