多发肋骨骨折合并中重度创伤性脑损伤患者行手术固定肋骨与非手术治疗的疗效比较（CWIS-TBI）。
Outcome after surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures and moderate to severe traumatic brain injury (CWIS-TBI).
机构信息
From the Trauma Research Unit, Department of Surgery (J.T.H.P., E.M.M.V.L., M.H.J.V., M.M.E.W.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Surgery (F.A.-O.), HonorHealth John C. Lincoln Medical Center, Phoenix, Arizona; Division of Trauma, Emergency General Surgery, Critical Care Surgery, Department of Surgery (Z.M.B.), University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (E.-C.C.), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Section of Acute Care Surgery, Department of Surgery (J.C., J.D.F.), Stanford University, Stanford, California; Department of Trauma Surgery/Critical Care (D.B.C., T.N.), Mercer University School of Medicine, The Medical Center Navicent Health, Macon, Georgia; HealthPartners Orthopedics & Sports Medicine (P.A.C.), Bloomington; Department of Orthopaedic Surgery (P.A.C.), University of Minnesota, Minneapolis; Department of Orthopaedic Surgery (P.A.C.), Regions Hospital, St. Paul, Minnesota; Department of Surgery (W.B.D., D.G.H.), Riverside Methodist Hospital, Columbus, Ohio; Department of Surgery (A.R.D., B.G.), Saint Francis Hospital, Hartfort, Connecticut; Division of Trauma and Critical Care, Department of Surgery (E.A.E., S.L.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (D.R.F., A.G.M.), UNLV School of Medicine, Las Vegas, Nevada; Division of Trauma, Department of Surgery (C.H., G.R.S.), Wright State University/Miami Valley Hospital, Dayton, Ohio; Department of Surgery (A.J.K., P.P.), Overland Park Regional Medical Center, Overland Park, Kansas; Division of Trauma Surgery, Department of Surgery (H.-J.K., Y.-H.S.), National Taiwan University Hospital, Hsinchu City, Taiwan; Department of Surgery (K.N.L.), Denver Health Medical Center, Denver, Colorado; CJOB Department of Cardiothoracic Surgery (S.F.M.), The Alfred, Melbourne; Department of Surgery (S.F.M.), Monash University, Clayton, Victoria, Australia; Department of Orthopaedic Surgery (T.D.O.), University of Minnesota, Minneapolis; Department of Orthopaedic Surgery (T.D.O.), Regions Hospital, St. Paul, Minnesota; Department of Surgery (A.P.R.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Department of Trauma/Burn (V.S.), John H Stronger Hospital of Cook County, Chicago, Illinois; Department of Surgery (J.W.), University of Texas Rio Grande Valley, Doctors Hospital at Renaissance, Edinburg, Texas; Department of Surgery (F.M.P.), Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado.
出版信息
J Trauma Acute Care Surg. 2021 Mar 1;90(3):492-500. doi: 10.1097/TA.0000000000002994.
BACKGROUND
Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared with nonoperative management, is associated with favorable outcomes in patients with TBI.
METHODS
A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were intensive care unit length of stay and hospital length of stay, tracheostomy, occurrence of complications, neurologic outcome, and mortality. Patients were further stratified into moderate (GCS score, 9-12) and severe (GCS score, ≤8) TBI.
RESULTS
The study cohort consisted of 456 patients of which 111 (24.3%) underwent SSRF. The SSRF was performed at a median of 3 days, and SSRF-related complication rate was 3.6%. In multivariable analyses, there was no difference in mechanical ventilation-free days between the SSRF and nonoperative groups. The odds of developing pneumonia (odds ratio [OR], 0.59; 95% confidence interval [95% CI], 0.38-0.98; p = 0.043) and 30-day mortality (OR, 0.32; 95% CI, 0.11-0.91; p = 0.032) were significantly lower in the SSRF group. Patients with moderate TBI had similar outcome in both groups. In patients with severe TBI, the odds of 30-day mortality was significantly lower after SSRF (OR, 0.19; 95% CI, 0.04-0.88; p = 0.034).
CONCLUSION
In patients with multiple rib fractures and TBI, the mechanical ventilation-free days did not differ between the two treatment groups. In addition, SSRF was associated with a significantly lower risk of pneumonia and 30-day mortality. In patients with moderate TBI, outcome was similar. In patients with severe TBI a lower 30-day mortality was observed. There was a low SSRF-related complication risk. These data suggest a potential role for SSRF in select patients with TBI.
LEVEL OF EVIDENCE
Therapeutic, level IV.
背景
多发肋骨骨折合并创伤性脑损伤（TBI）患者的外科肋骨固定术（SSRF）治疗效果尚未研究。我们假设与非手术治疗相比，SSRF 可改善 TBI 患者的预后。
方法
本多中心回顾性队列研究纳入 2012 年 1 月至 2019 年 7 月期间接受肋骨骨折合并 TBI 治疗的患者。比较了接受 SSRF 治疗的患者与接受非手术治疗的患者。主要结局是机械通气无天数。次要结局是重症监护病房住院时间、医院住院时间、气管切开术、并发症发生率、神经功能预后和死亡率。患者进一步分为中度（GCS 评分 9-12）和重度（GCS 评分≤8）TBI。
结果
研究队列包括 456 例患者，其中 111 例（24.3%）接受了 SSRF。SSRF 中位时间为 3 天，SSRF 相关并发症发生率为 3.6%。多变量分析显示，SSRF 组与非手术组之间机械通气无天数无差异。SSR 组发生肺炎的几率（比值比[OR]，0.59；95%置信区间[95%CI]，0.38-0.98；p = 0.043）和 30 天死亡率（OR，0.32；95%CI，0.11-0.91；p = 0.032）显著降低。中度 TBI 患者两组的预后相似。在重度 TBI 患者中，SSR 后 30 天死亡率的几率显著降低（OR，0.19；95%CI，0.04-0.88；p = 0.034）。
结论
在多发肋骨骨折合并 TBI 患者中，两组的机械通气无天数无差异。此外，SSRF 与肺炎和 30 天死亡率降低显著相关。中度 TBI 患者的预后相似。重度 TBI 患者的 30 天死亡率较低。SSR 相关并发症的风险较低。这些数据提示 SSRF 在某些 TBI 患者中可能具有潜在作用。
证据水平
治疗性，IV 级。
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