Golic Darko Aleksa, Svraka Dragan, Keleman Nataša, Petrovic Snjezana
Medical Faculty of Banja Luka, University Clinical Center of Republic of Srpska, University Banja Luka, Banjaluka, Bosnia and Herzegovina.
Front Med (Lausanne). 2018 Oct 4;5:280. doi: 10.3389/fmed.2018.00280. eCollection 2018.
Flail chest, often defined as the fracture of three or more ribs in two or more places, represents the most severe form of rib fractures. Conservative treatment, consisting of respiratory assistance with endotracheal intubation and mechanical ventilation (internal pneumatic stabilization) and pain control, are the current treatments of choice in the majority of patients with multiple rib fractures. However, the use of mechanical ventilation may create complications. In selected patients, operative fixation of fractured ribs within 72 h post injury may lead to better outcomes. We conducted a retrospective analysis of a series of nine cases of patients who developed flail chest after blunt trauma, and were treated with surgical osteofixation of the chest wall and postoperative epidural analgesia at the University Clinical Center of the Republic of Srpska during the period from January 2015. to December 2016. Two patients had trauma to the chest only, and the other patients had associated injuries to the head, abdomen, spine, and fractures of the pelvis and long bones. In the majority of patients (77.7%), surgical stabilization of the chest was performed on the second day following the injury, (mean, 2.33 days) and no later than 5 days after the injury. All patients received epidural analgesia with 0, 25% bupivacaine and 0, 01% morphine and intravenous multimodal analgesia, beginning 6 h after thoracotomy. The average length of ICU stay was 14.7 days (range 2-36), while the average number of days of mechanical ventilation was 8.1. The average duration of hospitalization was 25.4 days. Tracheotomy was performed in 33.3% of study patients. Mortality in the observed group was 44.4%. This study shows that surgical stabilization and epidural analgesia reduced ventilator support, shortened trauma intensive care unit stay, and reduced medical costs vs internal pneumatic stabilization.
连枷胸通常被定义为三根或更多肋骨在两个或更多部位发生骨折，是肋骨骨折最严重的形式。保守治疗包括气管插管和机械通气的呼吸辅助（内部充气稳定）以及疼痛控制，是大多数多根肋骨骨折患者目前的首选治疗方法。然而，使用机械通气可能会引发并发症。在特定患者中，受伤后72小时内对骨折肋骨进行手术固定可能会带来更好的治疗效果。我们对2015年1月至2016年12月期间在塞尔维亚共和国斯普斯卡大学临床中心发生钝性创伤后出现连枷胸并接受胸壁手术骨固定和术后硬膜外镇痛治疗的一系列9例患者进行了回顾性分析。2例患者仅胸部受伤，其他患者伴有头部、腹部、脊柱损伤以及骨盆和长骨骨折。大多数患者（77.7%）在受伤后的第二天（平均2.33天）且不晚于受伤后5天进行了胸部手术稳定治疗。所有患者在开胸术后6小时开始接受0.25%布比卡因和0.01%吗啡的硬膜外镇痛以及静脉多模式镇痛。重症监护病房（ICU）的平均住院时间为14.7天（范围2 - 36天），而机械通气的平均天数为8.1天。平均住院时长为25.4天。33.3%的研究患者进行了气管切开术。观察组的死亡率为44.4%。这项研究表明，与内部充气稳定相比，手术稳定和硬膜外镇痛减少了呼吸机支持，缩短了创伤重症监护病房的住院时间，并降低了医疗费用。
