创伤性肋骨骨折：严重损伤的一个标志。一项使用国家创伤数据库的全国性研究。
Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank.
作者信息
Peek Jesse, Ochen Yassine, Saillant Noelle, Groenwold Rolf H H, Leenen Loek P H, Uribe-Leitz Tarsicio, Houwert R Marijn, Heng Marilyn
机构信息
Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
Trauma Surg Acute Care Open. 2020 Jun 10;5(1):e000441. doi: 10.1136/tsaco-2020-000441. eCollection 2020.
BACKGROUND
In recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.
METHODS
A retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.
RESULTS
Of the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).
DISCUSSION
Traumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.
LEVEL OF EVIDENCE
II/III.
背景
近年来，肋骨骨折患者的治疗受到越来越多的关注。然而，目前关于肋骨骨折的流行病学和治疗结果的文献已过时且不一致。此外，尽管有人提出创伤性肋骨骨折患者之间存在很大的异质性，但关于不同亚组治疗结果的文献报道不足。
方法
使用国家创伤数据库进行了一项回顾性队列研究。通过国际疾病分类第九版诊断代码确定了2010年1月至2016年12月期间入院的所有患有一处或多处创伤性肋骨骨折或连枷胸的成年患者。
结果
在纳入的564798例有一处或多处肋骨骨折的患者中，44.9%（n = 253564）为多发伤患者。2.0%（n = 11433）有开放性肋骨骨折，4.1%（n = 23388）的所有病例发现有连枷胸。在多发伤和连枷胸患者中，机动车事故（n = 237995，51.6%）是肋骨骨折最常见的原因。钝性胸部损伤占肋骨骨折的95.5%（n = 539422）。老年患者的肋骨骨折主要由高能量和低能量跌倒引起（n = 67675，51.9%）。最终，所有患者中有49.5%（n = 279615）入住重症监护病房，其中四分之一（n = 146191，25.9%）需要有创机械通气支持。总体死亡率为5.6%（n = 31524）。
讨论
创伤性肋骨骨折是严重损伤的一个标志，因为大约一半的患者为多发伤患者。此外，肋骨骨折患者是一个非常异质的群体，在流行病学、损伤特征和住院治疗结果方面存在相当大的差异。在多发伤和连枷胸患者中主要观察到较差的治疗结果。未来的研究应认识到这些差异，并相应地评估治疗方法。
证据水平
II/III。
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