单发或多发肋骨骨折患者的长期肺功能、胸痛和生活质量。
Long-term pulmonary function, thoracic pain, and quality of life in patients with one or more rib fractures.
机构信息
From the Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
出版信息
J Trauma Acute Care Surg. 2021 Dec 1;91(6):923-931. doi: 10.1097/TA.0000000000003378.
BACKGROUND
Long-term outcomes after rib fractures and the effect of treatment modality or chest wall injury severity on these outcomes remains uncertain. This retrospective cohort study evaluated the long-term pulmonary function, thoracic pain, and quality of life in patients admitted with rib fractures.
METHODS
Patients admitted with rib fractures between January 1, 2012, and December 1, 2019, were included. Data on long-term outcomes were collected during one follow-up visit. Patients were stratified by chest wall injury severity (one or two rib fractures, ≥3 rib fractures, or a flail chest) and treatment modality (surgical stabilization of rib fractures [SSRF] or nonoperative management). Multivariable analysis was performed to compare outcomes after SSRF with nonoperative treatment in patients with three or more rib fractures.
RESULTS
In total, 300 patients were included. The median follow-up was 39 months (P25-P75, 18-65 months). At follow-up, the corrected forced vital capacity returned to 84.7% (P25-P75, 74.3-93.7) and the forced expiratory volume in 1 second to 86.3% (P25-P75, 75.3-97.0) of the predicted reference values. Quality of life was determined using the Short Form-12 version 2 and EuroQoL-5D-5L. The Short Form-12 version 2 physical and mental component summary were 45 (P25-P75, 38-54) and 53 (P25-P75, 43-60), respectively. The EuroQoL-5D-5L utility score was 0.82 (P25-P75 0.66-0.92) and visual analog scale score 75 (P25-P75 70-85). This indicated a quality of life within normal population ranges. Moderate to severe thoracic pain was reported by 64 (21.3%) patients. Long-term outcomes returned to values within population ranges and were similar across chest wall injury severity and for patients treated with SSRF or nonoperatively.
CONCLUSION
While long-term pulmonary function and quality of life recover to values considered normal, subjective thoracic complaints, such as pain and dyspnea, remain frequently present following rib fractures. No effect of chest wall injury severity or treatment modality on long-term outcomes was demonstrated.
LEVEL OF EVIDENCE
Therapeutic, level III.
背景
肋骨骨折的长期预后以及治疗方式或胸壁损伤严重程度对这些结果的影响仍不确定。本回顾性队列研究评估了因肋骨骨折住院患者的长期肺功能、胸疼和生活质量。
方法
纳入 2012 年 1 月 1 日至 2019 年 12 月 1 日期间因肋骨骨折住院的患者。在一次随访期间收集长期结果数据。根据胸壁损伤严重程度（一根或两根肋骨骨折、≥3 根肋骨骨折或连枷胸）和治疗方式（肋骨骨折手术固定[SSRF]或非手术治疗）对患者进行分层。对 3 根或更多肋骨骨折患者的 SSRF 与非手术治疗后的结果进行多变量分析。
结果
共纳入 300 例患者。中位随访时间为 39 个月（P25-P75，18-65 个月）。随访时，校正后的用力肺活量恢复至预计参考值的 84.7%（P25-P75，74.3-93.7），1 秒用力呼气量恢复至 86.3%（P25-P75，75.3-97.0）。生活质量采用健康调查简表 12 版本 2（Short Form-12 version 2）和欧洲五维健康量表 5 维度 5 级量表（EuroQoL-5D-5L）进行评估。健康调查简表 12 版本 2 生理和心理成分综合评分分别为 45（P25-P75，38-54）和 53（P25-P75，43-60），欧洲五维健康量表 5 维度 5 级量表效用评分 0.82（P25-P75，0.66-0.92），视觉模拟评分 75（P25-P75，70-85）。这表明生活质量处于正常人群范围内。64 例（21.3%）患者报告存在中度至重度胸疼。长期结果恢复到人群范围内的值，且在胸壁损伤严重程度和接受 SSRF 或非手术治疗的患者中相似。
结论
尽管长期肺功能和生活质量恢复到被认为正常的值，但肋骨骨折后，仍经常出现主观胸疼等症状，如疼痛和呼吸困难。未发现胸壁损伤严重程度或治疗方式对长期结果有影响。
证据水平
治疗性，III 级。
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