OhioHealth/Doctors Hospital, Department of Orthopedics, Columbus, OH 43228, United States.
OhioHealth/Doctors Hospital, Department of Orthopedics, Columbus, OH 43228, United States.
Injury. 2021 May;52(5):1133-1137. doi: 10.1016/j.injury.2020.12.021. Epub 2020 Dec 26.
Far posterior, or paraspinal rib fractures, defined as fractures that are medial to the medial border of the scapula (and may involve the costovertebral articulation), are often treated nonoperatively. However, in certain cases, including severe displacement, persistent pain, nonunion, or persistent respiratory distress, stabilization with open reduction and internal fixation (ORIF) may be warranted. There is a paucity of literature regarding the surgical approach and clinical outcomes following ORIF for far posterior rib fractures and fracture-dislocations. The purpose of this paper is to describe the surgical approach and to report the first collection of clinical outcomes for patients undergoing paraspinal rib ORIF.
A retrospective case series was performed at a single urban level 1 trauma center. Patients 18 years of age or older who underwent ORIF of far posterior rib fractures were included in this study. Far posterior rib fractures were defined as fractures that occurred medial to the medial border of the scapula underneath the paraspinal musculature. Data collection including patient demographics, injury characteristics, operative variables, and postoperative outcomes were collected and analyzed.
Twenty-six patients, with a mean age of 50.7 years, who underwent paraspinal rib ORIF were included in this study. The mean follow-up was 12.1 months. 80.8% of patients had a flail chest injury. On average, 3.4 ribs were instrumented posteriorly with 22.8% of patients requiring fixation spanning the costotransverse articulation. No intraoperative complications occurred. Only one patient required a repeat procedure. Total hospital length of stay averaged 17.3 days with an intensive care unit stay averaging 6.2 days. Total ventilator time averaged 4 days. 7 patients were diagnosed with postoperative pneumonia and 6 patients required tracheostomy.
Open reduction and internal fixation for far posterior, or paraspinal rib fractures and fracture-dislocations is a safe procedure with low complications rates and favorable postoperative outcomes including hospital length of stay, ICU length of stay, need for tracheostomy, postoperative pneumonia, and mechanical ventilation time.
远后段或脊柱旁肋骨骨折，定义为位于肩胛骨内侧缘内侧（可能涉及肋椎关节）的骨折，通常采用非手术治疗。然而，在某些情况下，包括严重移位、持续疼痛、不愈合或持续呼吸困难，可能需要进行开放复位和内固定（ORIF）以稳定病情。关于远后段肋骨骨折和骨折脱位的 ORIF 手术入路和临床结果的文献很少。本文旨在描述手术入路，并报告首例接受脊柱旁肋骨 ORIF 治疗的患者的临床结果。
在一家单一的城市一级创伤中心进行了回顾性病例系列研究。本研究纳入了年龄在 18 岁及以上接受远后段肋骨 ORIF 的患者。远后段肋骨骨折定义为发生在肩胛骨内侧缘下脊柱旁肌肉内的骨折。收集了患者的人口统计学、损伤特征、手术变量和术后结果等数据，并进行了分析。
本研究纳入了 26 例患者，平均年龄为 50.7 岁，接受了脊柱旁肋骨 ORIF。平均随访时间为 12.1 个月。80.8%的患者有连枷胸损伤。平均有 3.4 根肋骨接受了后路器械固定，22.8%的患者需要固定跨越肋横突关节。术中无并发症发生。仅 1 例患者需要再次手术。总住院时间平均为 17.3 天，重症监护病房停留时间平均为 6.2 天。总呼吸机使用时间平均为 4 天。7 例患者诊断为术后肺炎，6 例患者需要行气管切开术。
远后段或脊柱旁肋骨骨折和骨折脱位的 ORIF 是一种安全的手术方法，并发症发生率低，术后结果良好，包括住院时间、重症监护病房停留时间、气管切开术需要、术后肺炎和机械通气时间。
