手术与非手术治疗连枷胸的早期结果：一项关注结局和并发症的回顾性研究。
Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications.
机构信息
Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
出版信息
Eur J Trauma Emerg Surg. 2020 Jun;46(3):539-547. doi: 10.1007/s00068-018-0961-4. Epub 2018 May 21.
PURPOSE
Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with non-operative treatment, with special focus on the impact of surgical complications.
METHODS
A retrospective case series of operatively treated flail chest patients was compared with non-operatively treated patients. Patients' injury and treatment characteristics and outcome parameters (e.g., duration of mechanical ventilation, length of Intensive Care stay (ICLOS) and hospital length of stay (HLOS), mortality, surgery-related complications and pneumonia) were collected from the patients' medical files. Crude and matched-pairs analyses were performed in SPSS.
RESULTS: Twenty-three operatively and 47 non-operatively treated patients were enrolled. Operatively treated patients required significantly shorter mechanical ventilation; median 4 days versus 12 days for the non-operative group (p = 0.011). The matched-pairs analysis also showed a lower pneumonia rate (35% versus 80%; p = 0.035) and a shorter HLOS (median 21 versus 23 days; p = 0.028) in the operative group. No significant differences in duration of ICLOS, and occurrence of other injury-related adverse events were found between both groups. Seven surgery-related complications occurred, of which three required invasive solutions.
CONCLUSIONS
Operative fixation of a flail chest in trauma patients results in a lower rate of pneumonia, less mechanical ventilation days and shorter hospital stay, compared with non-operative treatment, but at the cost of surgery-related complications requiring invasive solutions in some cases.
目的
传统上，连枷胸采用机械通气和疼痛控制的非手术治疗。为了降低与通气相关的并发症和长期残疾的发生率，手术肋骨固定术已成为这些患者的标准治疗方法。然而，手术并发症的后果可能会对成功率产生负面影响。本研究旨在比较手术固定肋骨与非手术治疗连枷胸的治疗效果，特别关注手术并发症的影响。
方法
回顾性地比较了手术治疗连枷胸患者与非手术治疗患者的病例系列。从患者的病历中收集了患者的损伤和治疗特征以及结果参数（例如，机械通气时间、重症监护病房住院时间（ICLOS）和住院时间（HLOS）、死亡率、手术相关并发症和肺炎）。在 SPSS 中进行了未校正和配对分析。
结果
共纳入 23 例手术治疗和 47 例非手术治疗患者。手术治疗患者需要的机械通气时间明显更短；中位数为 4 天，而非手术组为 12 天（p=0.011）。配对分析还显示，手术组肺炎发生率（35%比 80%；p=0.035）和 HLOS 较短（中位数 21 天比 23 天；p=0.028）。两组间 ICLOS 持续时间和其他与损伤相关的不良事件发生率无显著差异。
发生了 7 例手术相关并发症，其中 3 例需要侵入性治疗。
结论
与非手术治疗相比，创伤患者连枷胸的手术固定可降低肺炎发生率、减少机械通气天数和缩短住院时间，但需要手术相关并发症在某些情况下需要侵入性治疗。
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