Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA.
Eur J Trauma Emerg Surg. 2022 Feb;48(1):225-230. doi: 10.1007/s00068-020-01568-x. Epub 2021 Jan 2.
Sternal fractures are debilitating due to intractable pain, constant fracture movement and limited range of motion (ROM) of the upper extremities (UE). Traditional treatment comprises mainly of pain control, delaying return to daily activities. Recently, sternal fixation has gained popularity. There is, however, a lack of literature demonstrating efficacy. We report our experience of traumatically fractured sternal fixation.
Following IRB approval, a retrospective chart review was completed for all patients undergoing sternal fixation by a single trauma surgeon at our Level I trauma center. Basic demographics were obtained. Primary outcomes included average cumulative pain scores, total cumulative narcotic amounts and total number of pain medication agents utilized prior to and after sternal fixation. Secondary outcome included physical therapy UE ROM before and after surgery. Paired t tests were used for comparison; significance set at p < 0.05.
Thirteen patients underwent sternal fixation from 8/2016 to 2/2018. Average age was 54.4 ± 20.8 years; 54% were female. All patients experienced blunt trauma; average injury severity score was 15.8 ± 10.9 and abbreviated chest injury score was 2.5 ± 0.51. Average intensive care unit/hospital length of stay was 2.3/10.2 days. Average pain scores significantly improved by a score of 3.5 postoperatively (preoperative = 7.08 ± 2.3, postoperative = 3.54 ± 2.5; p = 0.001). Total pain medications required by sternal fixation patients significantly decreased by 1 medication postoperatively (preoperative = 4.2 medications, postoperative = 3.2 medications; p = 0.002). Average narcotic requirements significantly decreased by 7.59 morphine milligram milliequivalents (MME) after sternal fixation (preoperative amount = 71.78 MME, postoperative amount = 64.19 MME; p = 0.041). Every patient had limited UE ROM preoperatively; however, all but one patient resumed full UE ROM postoperatively (p < 0.001). There were no postoperative complications.
Sternal fixation is a safe and effective procedure resulting in improved pain, decreased narcotic requirements, and faster recovery.
胸骨骨折会导致难以忍受的疼痛、骨折持续移动以及上肢活动范围（ROM）受限，从而使人虚弱。传统的治疗方法主要包括控制疼痛，延迟恢复日常活动。最近，胸骨固定术越来越受欢迎。但是，目前缺乏相关疗效的文献。我们报告了我们在创伤性胸骨骨折固定方面的经验。
在获得机构审查委员会批准后，我们对在我们的一级创伤中心由一名创伤外科医生进行胸骨固定的所有患者进行了回顾性图表审查。获取了基本人口统计学数据。主要结果包括固定前和固定后的平均累积疼痛评分、总累积阿片类药物用量和使用的止痛药总数。次要结果包括手术前后上肢 ROM 的物理治疗。使用配对 t 检验进行比较；显著性水平设为 p<0.05。
2016 年 8 月至 2018 年 2 月，13 名患者接受了胸骨固定术。平均年龄为 54.4±20.8 岁；54%为女性。所有患者均经历了钝性创伤；平均损伤严重程度评分为 15.8±10.9，简化胸部损伤评分为 2.5±0.51。平均 ICU/住院时间为 2.3/10.2 天。平均疼痛评分术后显著改善 3.5 分（术前=7.08±2.3，术后=3.54±2.5；p=0.001）。接受胸骨固定术的患者所需的止痛药总数术后显著减少了 1 种（术前=4.2 种药物，术后=3.2 种药物；p=0.002）。接受胸骨固定术后，阿片类药物的需求量平均减少了 7.59 吗啡毫克毫当量（MME）（术前用量=71.78 MME，术后用量=64.19 MME；p=0.041）。所有患者术前上肢 ROM 均受限，但除 1 例患者外，所有患者术后均恢复了完全的上肢 ROM（p<0.001）。术后无并发症。
胸骨固定术是一种安全有效的方法，可改善疼痛、减少阿片类药物的需求，并加速康复。
