Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Feb;48(1):255-264. doi: 10.1007/s00068-020-01470-6. Epub 2020 Sep 2.
The primary aim of this study was to assess the long-term quality of life and functional outcome after rib fracture fixation for patients with multiple rib fractures or flail chest. Secondarily, this study sought to identify risk factors associated with the quality of life.
A retrospective cohort study with a follow-up by questionnaire was performed at a level-1 trauma center in Switzerland. All adult patients with three or more rib fractures treated with rib fixation between 2010 and 2018 were eligible for inclusion. All outcomes were independently assessed for patients with multiple rib fractures and patients with a flail chest. The outcome measures were quality of life, level of dyspnea, return to work, implant irritation, and implant removal after a minimum of 12 months of follow-up. Quality of life was assessed using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) and level of dyspnea was determined with the modified Medical Research Council dyspnea (mMRC) scale.
The survey was completed by 74 out of 102 patients (73%) at a median follow-up of 26 months (IQR 15-37). The median EQ-5D utility index score was 0.91 (0.89-1.0), which was equivalent to the reference population (0.902, p = 0.523). The vast majority of patients experienced 'no problems' or 'slight problems' in any of the EQ-5D-5L dimensions. The complication rate associated with rib fracture fixation was low, implant-related irritation was the most common long-term sequela and occurred in 31% of patients. In multivariable regression analyses, total length of stay on the intensive care unit (ICU-LOS) was independently associated with a worse quality of life.
Patients who underwent rib fracture fixation for multiple rib fractures or flail chest after severe chest trauma experienced a good quality of life at least 1 year after surgery. A longer ICU-LOS was independently associated with impaired quality of life. In addition, there were no significant differences in the long-term quality of life and functional outcome between patients with multiple rib fractures and a flail chest. Implant-related irritation was the most important long-term sequela and occurred in one-third of patients.
本研究的主要目的是评估多发性肋骨骨折或连枷胸患者肋骨骨折固定后的长期生活质量和功能结局。其次，本研究旨在确定与生活质量相关的危险因素。
这是一项在瑞士 1 级创伤中心进行的回顾性队列研究，通过问卷调查进行随访。2010 年至 2018 年间，所有接受肋骨固定治疗的三根或三根以上肋骨骨折的成年患者均符合纳入标准。所有结果均独立评估多发性肋骨骨折患者和连枷胸患者。主要结局指标为生活质量、呼吸困难程度、重返工作岗位、植入物刺激和至少 12 个月随访后的植入物取出。生活质量采用欧洲五维健康量表（EQ-5D-5L）评估，呼吸困难程度采用改良的医学研究委员会呼吸困难量表（mMRC）评估。
在中位随访 26 个月（IQR 15-37）时，102 例患者中有 74 例（73%）完成了调查。中位 EQ-5D 效用指数评分为 0.91（0.89-1.0），与参考人群（0.902，p=0.523）相当。绝大多数患者在 EQ-5D-5L 的任何维度均报告“无问题”或“轻微问题”。肋骨骨折固定相关并发症发生率较低，植入物相关刺激是最常见的长期后遗症，发生在 31%的患者中。多变量回归分析显示，重症监护病房（ICU）住院时间（ICU-LOS）与生活质量较差独立相关。
严重胸部创伤后接受多发性肋骨骨折或连枷胸肋骨骨折固定的患者，术后至少 1 年生活质量良好。ICU-LOS 较长与生活质量受损独立相关。此外，多发性肋骨骨折和连枷胸患者的长期生活质量和功能结局无显著差异。植入物相关刺激是最重要的长期后遗症，发生在三分之一的患者中。
