He Zhe, Zhang Dongsheng, Xiao Haiping, Zhu Qihang, Xuan Yiwen, Su Kai, Liao Ming, Tang Yong, Xu Enwu
Department of Thoracic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China.
Department of Thoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang 050011, China.
J Thorac Dis. 2019 May;11(Suppl 8):S1078-S1089. doi: 10.21037/jtd.2019.04.109.
The clinical treatment choices for multiple rib fractures and flail chest are controversial. For example, among conservative treatment and surgical treatment, different studies have different conclusions and recommendations. Furthermore, early clinical research was mainly focused on the treatment of flail chest due to its severity. Nowadays, the treatment for multiple rib fractures patients without a flail chest is drawing an increased clinical interest. However, we are facing many challenges for the treatment of rib fractures, such as insufficient understanding of the available treatment options, lack of clinical research, lack of the internationally recognized clinical indication for the surgical stabilization of rib fractures (SSRF), and the constant controversies and debates in terms of treatment options, surgery timing, and surgical techniques. All these challenges make it difficult to select the most appropriated clinical decisions for the proper treatment of a rib fracture, resulting in a seriously hindered development of novel rib fractures treatment choices. The concepts and ideas for traditional rib fractures treatment are relatively old, and even have some misunderstandings or errors. With the emergence of more and more research, the understandings of the rib fractures treatment has gradually improved; for example, the benefits provided to patients under the open reductions and internal fixation of fractures treatment. In this article, we outlined the new concepts in rib fractures treatment, which mainly included four parts, damage control, pain management, fixation selection, and quality of life. We hope these concepts help practitioners better manage rib fracture patients.
多发性肋骨骨折和连枷胸的临床治疗选择存在争议。例如，在保守治疗和手术治疗之间，不同的研究有不同的结论和建议。此外，早期临床研究主要集中在连枷胸的治疗上，因为其病情严重。如今，对于无连枷胸的多发性肋骨骨折患者的治疗正引起越来越多的临床关注。然而，我们在肋骨骨折的治疗上面临着许多挑战，比如对现有治疗选择的认识不足、缺乏临床研究、缺乏国际公认的肋骨骨折手术固定（SSRF）的临床指征，以及在治疗选择、手术时机和手术技术方面持续存在的争议和辩论。所有这些挑战使得难以选择最恰当的临床决策来妥善治疗肋骨骨折，导致新型肋骨骨折治疗选择的发展严重受阻。传统肋骨骨折治疗的概念和理念相对陈旧，甚至存在一些误解或错误。随着越来越多研究的出现，对肋骨骨折治疗的认识逐渐提高；例如，骨折切开复位内固定治疗为患者带来的益处。在本文中，我们概述了肋骨骨折治疗的新概念，主要包括四个部分，即损伤控制、疼痛管理、固定选择和生活质量。我们希望这些概念能帮助从业者更好地管理肋骨骨折患者。
