Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, 68198-3280, USA.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):1965-1970. doi: 10.1007/s00068-020-01353-w. Epub 2020 Mar 27.
Rib fractures (RF) occur in 10% of trauma patients; associated with significant morbidity and mortality. Despite advancing technology of surgical stabilization of rib fractures (SSRF), treatment and indications remain controversial. Lack of displacement is often cited as a reason for non-operative management. The purpose was to examine RF patterns hypothesizing RF become more displaced over time.
Retrospective review of all RF patients from 2016-2017 at our institution. Patients with initial chest CT (CT1) followed by repeat CT (CT2) within 84 days were included. Basic demographics were obtained. Primary outcomes included RF displacement in millimeters (mm) between CT1 and CT2 in three planes (AP = anterior/posterior, O = overlap/gap, and SI = superior/inferior). Displacement was calculated by subtracting CT1 fracture displacement from CT2 displacement for each rib. Given anatomic and clinical characteristics, ribs were grouped (1-2, 3-6, 7-10, 11-12), averaged, and analyzed for displacement. Secondary outcome included number of missed RF on CT1. Non-parametric sign test and paired t test were used for analysis. Significance was set at p < 0.002.
78 of 477 patients with RF on CT1 had CT2 during the study period: primarily male (76%) and age 55.8 ± 20.1 with blunt mechanism of injury (99%). Median Injury Severity Score was 21 (IQR, 13-27) with Chest Abbreviated Injury Score of 3 (IQR, 3-4). Median time between CT1 and CT2 was 6 days (IQR, 3-12). Missed RF rate for CT1 was 10.1% (p = 0.11). Average fracture displacement was significantly increased for all rib groupings except 11-12 in all planes (p < 0.002).
RF become more displaced over time. Pain regimens and SSRF considerations should be adjusted accordingly.
肋骨骨折（RF）在 10%的创伤患者中发生；与显著的发病率和死亡率相关。尽管肋骨骨折手术固定（SSRF）技术不断进步，但治疗和适应证仍存在争议。缺乏移位通常被认为是非手术治疗的原因。本研究旨在通过检查 RF 模式，假设 RF 随时间推移而变得更加移位。
对我院 2016-2017 年所有 RF 患者进行回顾性分析。纳入在 84 天内进行初始胸部 CT（CT1）并随后重复 CT（CT2）的患者。获得基本人口统计学数据。主要结局包括在三个平面（AP=前后，O=重叠/间隙，SI=上下）中 CT1 和 CT2 之间 RF 位移的毫米（mm）。通过从每个肋骨的 CT2 位移中减去 CT1 骨折位移来计算位移。根据解剖和临床特征，将肋骨分组（1-2、3-6、7-10、11-12），平均并分析其位移。次要结局包括 CT1 上漏诊的 RF 数量。使用非参数符号检验和配对 t 检验进行分析。显著性设为 p<0.002。
在 CT1 上有 RF 的 477 例患者中，78 例在研究期间进行了 CT2：主要为男性（76%），年龄 55.8±20.1 岁，钝器伤机制（99%）。中位损伤严重度评分 21（IQR，13-27），胸部简明损伤评分 3（IQR，3-4）。CT1 和 CT2 之间的中位时间为 6 天（IQR，3-12）。CT1 漏诊 RF 率为 10.1%（p=0.11）。除 11-12 肋骨外，所有肋骨组在所有平面上的平均骨折移位均显著增加（p<0.002）。
RF 随时间推移而变得更加移位。应相应调整疼痛治疗方案和 SSRF 考虑因素。
