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胸壁固定可缩短创伤性胸壁损伤后肋骨骨折患者的胸管留置时间。

Chest Wall Stabilization Leads to Shortened Chest Tube Stay Time in Rib Fracture Patients after Traumatic Chest Wall Injury.

作者信息

Fitzgerald Michael T, Ashley Dennis W, Abukhdeir Hesham, Christie D Benjamin

机构信息

Department of Trauma Surgery and Critical Care, The Medical Center, Navicent Health, Mercer University School of Medicine, Macon, Georgia, USA.

出版信息

Am Surg. 2018 May 1;84(5):680-683.

Abstract

Rib fixation has become a strategy for patients with displaced rib fractures and hemo/pneumothoraces (HTX/PTX). Rib plating improves pain control and respiratory mechanics, thereby reducing recovery times and morbidity/mortality. Current treatment consists of chest tube placement, pain control, and pulmonary toilet. The addition of rib plating should reduce time till HTX/PTX resolution and chest tube removal. The study compares chest tube stay time in rib-plated patients with those managed with current treatment. We hypothesize that patients undergoing rib plating will have a reduction in chest tube stay times. A retrospective review of a Level 1 trauma registry was performed. Rib-plated patients (n = 70) from 2013 to 2015 were compared with a randomly selected, nonoperative, injury-matched, historical (2003-2008) control group (n = 60). Demographics were obtained. Independent variables analyzed include Injury Severity Score (ISS), intensive care unit days, length of stay, and chest tube stay times. 60 control patients had an average ISS of 19 and age of 51 years, compared with ISS of 20 and age of 56 years in plated patients. Plated patients had a reduction in chest tube days, 6.5 versus 8.4 days, P value = 0.02. Plated patients had 14 intensive care unit days versus 19 days, P value = 0.09. T tests were performed to confirm significance. Reduction in chest tube days improves patient pain and allows for improved ambulation and pulmonary toilet, helping reduce respiratory complications. Our review shows that plating may prove beneficial in reducing complications associated with management of HTX/PTX in the setting of rib fractures.

摘要

肋骨固定已成为移位性肋骨骨折合并血胸/气胸(HTX/PTX)患者的一种治疗策略。肋骨接骨板固定可改善疼痛控制和呼吸力学,从而缩短恢复时间并降低发病率/死亡率。目前的治疗方法包括放置胸管、控制疼痛和肺部清洁。增加肋骨接骨板固定应可缩短HTX/PTX消散和拔除胸管的时间。本研究比较了接受肋骨接骨板固定患者与采用现行治疗方法患者的胸管留置时间。我们假设接受肋骨接骨板固定的患者胸管留置时间会缩短。对一级创伤登记处进行了回顾性研究。将2013年至2015年接受肋骨接骨板固定的患者(n = 70)与随机选择的、非手术的、损伤匹配的历史对照组(2003 - 2008年,n = 60)进行比较。获取了人口统计学数据。分析的自变量包括损伤严重度评分(ISS)、重症监护病房天数、住院时间和胸管留置时间。60名对照患者的平均ISS为19,年龄为51岁,相比之下,接受接骨板固定的患者ISS为20,年龄为56岁。接受接骨板固定的患者胸管留置天数减少,分别为6.5天和8.4天,P值 = 0.02。接受接骨板固定的患者在重症监护病房的天数为14天,而对照组为19天,P值 = 0.09。进行了t检验以确认显著性。胸管留置天数的减少改善了患者的疼痛状况,并使患者能够更好地活动和进行肺部清洁,有助于减少呼吸并发症。我们的研究表明,在肋骨骨折合并HTX/PTX的治疗中,接骨板固定可能有助于减少相关并发症。

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