老年（G60）创伤患者伴有严重肋骨骨折：保留肌肉的微创开胸肋骨固定术安全吗？它是否能改善术后肺功能？

Geriatric (G60) trauma patients with severe rib fractures: Is muscle sparing minimally invasive thoracotomy rib fixation safe and does it improve post-operative pulmonary function?

机构信息

HonorHealth John C. Lincoln Medical Center, USA.

HonorHealth Deer Valley Medical Center, USA.

出版信息

Am J Surg. 2018 Jul;216(1):46-51. doi: 10.1016/j.amjsurg.2018.02.022. Epub 2018 Feb 20.

DOI:10.1016/j.amjsurg.2018.02.022

PMID:29525055

Abstract

BACKGROUND

Patient outcomes after muscle sparing minimally invasive thoracotomy rib fixation (MSMIT-ORF) in geriatric G60 trauma patients remain poorly studied. This study determined the effect of MSMIT-ORF on pulmonary function (PFT). Non-operatively managed (NOM) patients were also described.

METHODS

Medical records of G60 patients with severe rib fractures with PFTs measured before and after MSMIT-ORF were examined. Patient outcomes (MSMIT-ORF vs NOM) were adjusted in a multivariate logistic regression model.

RESULTS

64 patients underwent MSMIT-ORF, 135 were NOM patients. MSMIT-ORF treated patients showed improvements in PFTs on postoperative day 5, p = 0.001. After adjustment analysis, MSMIT-ORF was associated with increased hospital length of stay (OR 44.9; 95% CI, 9.8-205, p < 0.001), but a more favorable discharge disposition. There was no difference in the rates of pneumonia (p = 0.996) or death (p = 0.140).

CONCLUSIONS

MSMIT-ORF is safe and improves pulmonary function in G60 trauma patients diagnosed with severe rib fractures. Future randomized control studies are needed for confirmation.

摘要

背景

老年 G60 创伤患者行肌保留微创开胸肋骨固定术（MSMIT-ORF）后的患者结局仍研究甚少。本研究旨在确定 MSMIT-ORF 对肺功能（PFT）的影响。同时也对非手术治疗（NOM）患者进行了描述。

方法

对接受 MSMIT-ORF 治疗且术前和术后均测量了 PFT 的 G60 严重肋骨骨折患者的病历进行了检查。采用多变量逻辑回归模型对患者结局（MSMIT-ORF 与 NOM）进行了调整。

结果

64 例患者接受了 MSMIT-ORF 治疗，135 例患者接受了 NOM 治疗。MSMIT-ORF 治疗组患者在术后第 5 天的 PFT 有改善，p=0.001。经调整分析后，MSMIT-ORF 与住院时间延长相关（OR 44.9；95%CI，9.8-205，p<0.001），但出院安置更为有利。肺炎发生率（p=0.996）或死亡率（p=0.140）无差异。