Rabiou S, Ouadnouni Y, Lakranbi M, Traibi A, Antoini F, Smahi M
Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc.
Service de chirurgie thoracique C1, CHU Hassan II, Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc.
Rev Pneumol Clin. 2018 Apr;74(2):89-95. doi: 10.1016/j.pneumo.2017.08.001. Epub 2017 Oct 14.
The rib fractures and instability of the chest wall are the main lesions of closed chest trauma. These lesions can be a source of chronic, often disabling with daily discomfort resulting limitation of some activities. The objective of this study was to assess the prevalence of this phenomenon in order to improve the quality of early care.
Through an observational retrospective cohort study on a number of 41 patients supported and monitored for traumatic rib fractures at the Military Hospital of Meknes during the period from October 2010 to March 2016.
The circumstances of the accident were dominated by accidents of public roads (86%) and concerned the young adult male. Radiographs have enumerated 165 fracture lines with an average of 4 rib fractures per patient. These were unilateral fractures in 88% of cases, and concerned the means arc in 46% of cases. The rib fracture was undisplaced fracture in 39% of patients, whereas in 2 patients, a flail chest was present. Post-traumatic hemothorax (63% of cases) were the thoracic lesions most commonly associated with rib fractures. The initial management consisted in the use of analgesics systemically in all patients. The retrospective evaluation of pain by the verbal scale was possible in 30 patients. The persistent pain was noted in 60% of cases. This pain was triggered by a simple effort to moderate in 55% of cases, and hard effort in 28% of cases. In 17% of patients, even at rest, the pain occurred intermittently. The impact in terms of disability was mild to moderate in 28% of cases and important in 17%. The neuropathic pain was found in 3 patients. Therapeutically, the first and second levels of analgesics were sufficient to relieve pain. The neuroleptics were required for 2 patients.
Our study confirms the persistence of chronic painful, sometimes lasting several years after the initial chest trauma. This pain is responsible of disability triggered most often after exercise.
肋骨骨折和胸壁不稳定是闭合性胸部创伤的主要损伤。这些损伤可能是慢性不适的根源，常常使人致残，导致日常不适，限制某些活动。本研究的目的是评估这一现象的发生率，以提高早期护理质量。
通过一项观察性回顾性队列研究，对2010年10月至2016年3月期间在梅克内斯军事医院接受支持和监测的41例创伤性肋骨骨折患者进行研究。
事故情况以公共道路事故为主（86%），涉及年轻成年男性。X线片显示有165条骨折线，平均每位患者有4根肋骨骨折。其中88%为单侧骨折，46%累及肋骨中段。39%的患者肋骨骨折为无移位骨折，2例患者出现连枷胸。创伤性血胸（63%的病例）是与肋骨骨折最常相关的胸部损伤。初始治疗包括对所有患者全身使用镇痛药。30例患者可以通过视觉模拟评分法对疼痛进行回顾性评估。60%的病例出现持续性疼痛。55%的病例中，这种疼痛由轻度活动引发，28%的病例由剧烈活动引发。17%的患者即使在休息时也会间歇性疼痛。28%的病例残疾影响为轻度至中度，17%为重度。3例患者出现神经性疼痛。在治疗方面，第一和第二级镇痛药足以缓解疼痛。2例患者需要使用抗精神病药物。
我们的研究证实了慢性疼痛的持续性，有时在初始胸部创伤后可持续数年。这种疼痛是运动后最常引发残疾的原因。
