Lee Yoonje, Lee Sang-Hyun, Kim Changsun, Choi Hyuk Joong
Department of Emergency Medicine, Seoul Hospital, Hanyang University, Gyeonggi-do Department of Emergency Medicine, Hangang Sacred Heart Hospital, Hallym University, Gangwon-do Department of Emergency Medicine, Guri Hospital, Hanyang University, Gyeonggi-do, Korea.
Medicine (Baltimore). 2018 May;97(21):e10779. doi: 10.1097/MD.0000000000010779.
In the treatment of patients with rib fractures (RFs), pain reduction is the most important consideration. Various studies have examined the effectiveness of treatments administered to RF patients, such as lidocaine patches, IV drugs, nerve blockers, and surgery. In this study, we evaluated the difference in the effectiveness in pain reduction between 2 groups of RF patients: 1 group who received a rib splint constructed in the ER (ER splint) and another group who received a Chrisofix Chest Orthosis (CCO) manufactured rib splint.
A pilot study for a prospective randomized clinical trial was conducted to compare subjects using the CCO (Group A) with those using the ER splint (Group B) before and after the intervention. The primary outcome was difference in the level of pain based on the visual analogue scale (VAS) and the pulmonary function (PF) variables between before and after intervention in each group during forceful and resting respiration.
A total of 24 subjects were enrolled in this study. The VAS results showed that the intervention was significantly effective in each group (before vs after: Group A resting: 8.50 ± 1.05 vs 4.17 ± 1.33, P < .001; Group A forceful: 9.83 ± 0.41 vs 7.17 ± 0.75, P < .001; Group B resting: 8.83 ± 1.60 vs 4.50 ± 1.38, P < .001; and Group B forceful: 9.67 ± 0.82 vs 7.33 ± 1.51, P = .003). The PF variables showed that the intervention was significantly effective in each group (before vs after: Group A, FVC: 2.74 ± 0.92 vs 3.35 ± 0.99, P < .001; FEV1: 2.16 ± 0.74 vs 2.57 ± 0.78, P = .001; PEF: 235.30 ± 43.06 vs 319.00 ± 51.58, P = .004; and Group B, FVC: 2.02 ± 0.49 vs 2.72 ± 0.62, P < .001; FEV1: 1.27 ± 0.25 vs 1.91 ± 0.37, P < .001; PEF: 216.67 ± 67.49 vs 300.33 ± 87.79, P = .003).
Applying either the CCO or the ER splint to RF patients effectively reduced pain, and no significant differences in pain level were observed between these 2 techniques.
在肋骨骨折（RF）患者的治疗中，减轻疼痛是最重要的考量因素。多项研究探讨了针对RF患者的各种治疗方法的有效性，如利多卡因贴片、静脉用药、神经阻滞剂和手术。在本研究中，我们评估了两组RF患者在减轻疼痛效果上的差异：一组接受在急诊室（ER）制作的肋骨夹板（ER夹板），另一组接受克里斯奥菲克斯胸部矫形器（CCO）制作的肋骨夹板。
进行了一项前瞻性随机临床试验的初步研究，以比较使用CCO的受试者（A组）和使用ER夹板的受试者（B组）在干预前后的情况。主要结局是基于视觉模拟量表（VAS）的疼痛水平差异以及每组在用力呼吸和静息呼吸时干预前后的肺功能（PF）变量。
本研究共纳入24名受试者。VAS结果显示，干预在每组中均具有显著效果（干预前与干预后：A组静息时：8.50±1.05 vs 4.17±1.33，P<.001；A组用力时：9.83±0.41 vs 7.17±0.75，P<.001；B组静息时：8.83±1.60 vs 4.50±1.38，P<.001；B组用力时：9.67±0.82 vs 7.33±1.51，P=.003）。PF变量显示，干预在每组中均具有显著效果（干预前与干预后：A组，用力肺活量（FVC）：2.74±0.92 vs 3.35±0.99，P<.001；第1秒用力呼气量（FEV1）：2.16±0.74 vs 2.57±0.78，P=.001；呼气峰值流速（PEF）：235.30±43.06 vs 319.00±51.58，P=.004；B组，FVC：2.02±0.49 vs 2.72±0.62，P<.001；FEV1：1.27±0.25 vs 1.91±0.37，P<.001；PEF：216.67±67.49 vs 300.33±87.79，P=.003）。
对RF患者应用CCO或ER夹板均可有效减轻疼痛，且这两种技术在疼痛水平上未观察到显著差异。
