Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands.
Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3513-3520. doi: 10.1007/s00068-021-01701-4. Epub 2021 Jun 1.
The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries.
A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14 of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant-Murley score, union and complications.
Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56-60.6% versus 29% in patients without clavicle fractures. Vice versa, 14-18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days).
Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury.
本系统评价的目的是提供锁骨和肋骨骨折合并发生率的概述，并探讨这两种损伤之间的关系。
于 2020 年 8 月 14 日在 MEDLINE、EMBASE 和 CENTRAL 数据库中进行了系统的文献检索。结局指标包括发生率、住院时间（HLOS）、重症监护病房（ICU）入院和住院时间（ILOS）、机械通气时间（DMV）、死亡率、胸腔引流管留置时间、Constant-Murley 评分、愈合情况和并发症。
纳入了 7 项研究，共 71572 例患者，其中 5 项研究为流行病学研究，2 项研究为治疗研究。在钝性胸部创伤患者中，合并锁骨和肋骨骨折的比例为 18.6%。合并锁骨骨折的多发创伤患者肋骨骨折发生率为 56%-60.6%，而无锁骨骨折的患者为 29%。相反，14%-18.8%的多发性肋骨骨折患者合并锁骨骨折，而无多发性肋骨骨折的患者为 7.1%。有一项研究报道了两种损伤固定后的无并发症。另一项关于治疗的研究报告称，与保守治疗相比，手术治疗的 ILOS 更短，并发症更少（5.4±1.5 天比 21±13.6 天）。
在多发创伤患者中，锁骨骨折和肋骨骨折密切相关，几乎五分之一的钝性胸部创伤患者同时存在这两种损伤。关于联合损伤的治疗，无法得出明确的结论。未来的研究应进一步探讨这种损伤手术治疗的适应证和获益。
