Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
J Orthop Trauma. 2019 Jan;33(1):23-30. doi: 10.1097/BOT.0000000000001316.
To determine whether operating on "major" vertebral fractures leads to premature abortion of surgery and/or other acute cardiopulmonary complications.
Retrospective review.
Level 1 trauma center.
PATIENTS/PARTICIPANTS AND INTERVENTION: We retrospectively queried our institutional Trauma Rregistry for all cases presenting with concomitant rib fractures and surgically managed vertebral fractures.
The main outcomes included the surgical outcome (aborted vs. successfully performed), total and Intensive Care Unit length of stay (LOS), adverse discharge, mortality, and functional outcomes.
We found 57 cases with concomitant segmental rib fractures and surgically managed vertebral fractures. Seven patients (12%) received a rib fixation, of which 1 received before vertebral fixation and 6 after. Importantly, 4 vertebral fixation cases (7.02%) had to be aborted intraoperatively because of the inability to tolerate prone positioning for surgery. For case-control analysis, we performed propensity score matching to obtain matched controls, that is, cases of vertebral fixation but no rib fractures. On matched case-control analysis, patients with concomitant segmental rib fractures and vertebral fractures were found to have higher Intensive Care Unit LOS [median = 3 days (Inter-Quartile Range = 0-9) versus. 8.4 days, P = 0.003], whereas total LOS, frequency of complete, incomplete or functional spinal cord injury, discharge to rehab, and discharge to nursing home were found to be similar between the 2 groups.
Our findings demonstrate that segmental rib fractures with concomitant vertebral fractures undergoing surgical treatment represent a subset of patients that may be at increased risk of intraoperative cardio-pulmonary complications and rib fixation before prone spine surgery for cases in which the neurological status is stable is reasonable.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定对“主要”脊柱骨折进行手术是否会导致手术提前流产和/或其他急性心肺并发症。
回顾性审查。
1 级创伤中心。
患者/参与者和干预措施：我们回顾性地查询了我们机构的创伤登记处，以获取所有同时伴有肋骨骨折和手术治疗的脊柱骨折的病例。
主要结果包括手术结果（流产与成功进行）、总住院时间和重症监护病房住院时间（LOS）、不良出院、死亡率和功能结果。
我们发现 57 例同时存在节段性肋骨骨折和手术治疗的脊柱骨折。7 例（12%）接受了肋骨固定，其中 1 例在脊柱固定前，6 例在脊柱固定后。重要的是，由于无法耐受俯卧位手术，有 4 例脊柱固定病例（7.02%）不得不术中流产。为了进行病例对照分析，我们进行了倾向评分匹配以获得匹配的对照组，即没有肋骨骨折但有脊柱固定的病例。在匹配的病例对照分析中，发现同时存在节段性肋骨骨折和脊柱骨折的患者重症监护病房 LOS 较高[中位数=3 天（四分位距=0-9）与 8.4 天，P=0.003]，而总 LOS、完全性、不完全性或功能性脊髓损伤的频率、康复出院和疗养院出院在两组之间相似。
我们的研究结果表明，接受手术治疗的同时伴有脊柱骨折的节段性肋骨骨折患者可能存在术中心肺并发症风险增加，对于神经状态稳定的病例，在俯卧位脊柱手术前进行肋骨固定是合理的。
预后 III 级。请参阅作者说明，以获取证据水平的完整描述。
