Dehghan Niloofar, Mah Jeffrey M, Schemitsch Emil H, Nauth Aaron, Vicente Milena, McKee Michael D
University of Arizona, Banner University Medical Center, The CORE Institute, Phoenix, AZ.
Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.
J Orthop Trauma. 2018 Jan;32(1):15-21. doi: 10.1097/BOT.0000000000000992.
To determine the prevalence, management and outcomes of patients with flail chest injuries, compared to patients without flail chest injuries (single rib fractures and multiple rib fractures without a flail segment).
Retrospective cohort study.
Ontario, Canada.
Ontario residents over the age of 16 years who had been admitted to hospital with a chest wall injury from 2004 to 2015 were identified using administrative health care databases.
Outcomes included treatment modalities such as rate of surgical repair, days on mechanical ventilation, days in the intensive care unit, days in hospital, rate of chest tube placement; and rates of complication, including pneumonia, tracheostomy, readmission, and death.
In total 117,204 patients with fractures of the chest wall were identified. Of the entire cohort, 1.5% of them had a flail chest injury, 41% had multiple rib fractures, and 58% had single rib fractures. Patients with flail chest injuries had significantly worse outcomes compared to patients with multiple rib fractures in all categories (P < 0.0001). Similarly, patients with multiple rib fractures had significantly worst outcomes compared with patients with single rib fractures (P < 0.0001). Only 4.5% of patients with flail chest injuries were treated surgically, however, the number increased from 1% before 2010 to 10% after 2010 (P < 0.0001). After adjustment for potential confounders, patients with flail chest injuries treated surgically had a reduced risk of early mortality compared to those treated nonoperatively (OR 0.16, P = 0.019).
Surgical stabilization of flail chest injuries has increased significantly in recent years. The results of this study provide preliminary evidence that the increasing rate of surgical intervention may be warranted by reducing mortality.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定连枷胸损伤患者的患病率、治疗方法及预后，并与无连枷胸损伤的患者（单根肋骨骨折和多根肋骨骨折但无连枷段）进行比较。
回顾性队列研究。
加拿大安大略省。
利用行政医疗保健数据库确定2004年至2015年因胸壁损伤入院的16岁以上安大略省居民。
结果包括治疗方式，如手术修复率、机械通气天数、重症监护病房天数、住院天数、胸管置入率；以及并发症发生率，包括肺炎、气管切开术、再入院和死亡。
共确定117204例胸壁骨折患者。在整个队列中，1.5%为连枷胸损伤，41%为多根肋骨骨折，其余58%为单根肋骨骨折。连枷胸损伤患者在所有类别中的预后均明显差于多根肋骨骨折患者（P<0.0001）。同样，多根肋骨骨折患者的预后明显差于单根肋骨骨折患者（P<0.0001）。只有4.5%的连枷胸损伤患者接受了手术治疗，但这一数字从2010年前的1%增加到2010年后的10%（P<0.0001）。在对潜在混杂因素进行调整后，与非手术治疗的连枷胸损伤患者相比，手术治疗的患者早期死亡风险降低（OR 0.16，P = 0.019）。
近年来，连枷胸损伤的手术固定显著增加。本研究结果提供了初步证据，表明手术干预率的增加可能因降低死亡率而具有合理性。
治疗性二级。有关证据级别的完整描述，请参阅作者指南。
