Department of Cardiothoracic Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400014, China.
Department of Trauma Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400014, China.
Chin J Traumatol. 2021 Nov;24(6):311-319. doi: 10.1016/j.cjtee.2021.07.012. Epub 2021 Aug 2.
Rib fracture is the most common injury in chest trauma. Most of patients with rib fractures were treated conservatively, but up to 50% of patients, especially those with combined injury such as flail chest, presented chronic pain or chest wall deformities, and more than 30% had long-term disabilities, unable to retain a full-time job. In the past two decades, surgery for rib fractures has achieving good outcomes. However, in clinic, there are still some problems including inconsistency in surgical indications and quality control in medical services. Before the year of 2018, there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad, focusing on the guidance of the overall treatment decisions and plans; another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures. The Chinese Society of Traumatology, Chinese Medical Association, and the Chinese College of Trauma Surgeons, Chinese Medical Doctor Association organized experts from cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics and other disciplines to participate together, following the principle of evidence-based medicine and in line with the scientific nature and practicality, formulated the Chinese consensus for surgical treatment of traumatic rib fractures (STTRF 2021). This expert consensus put forward some clear, applicable, and graded recommendations from seven aspects: preoperative imaging evaluation, surgical indications, timing of surgery, surgical methods, rib fracture sites for surgical fixation, internal fixation method and material selection, treatment of combined injuries in rib fractures, in order to provide guidance and reference for surgical treatment of traumatic rib fractures.
肋骨骨折是胸部创伤中最常见的损伤。大多数肋骨骨折患者接受保守治疗，但多达 50%的患者，特别是那些有连枷胸等合并伤的患者，会出现慢性疼痛或胸壁畸形，超过 30%的患者有长期残疾，无法全职工作。在过去的二十年中，肋骨骨折的手术治疗取得了良好的效果。然而，在临床实践中，仍然存在一些问题，包括手术指征的不一致和医疗服务的质量控制。2018 年之前，国内外发表了 3 篇关于区域性创伤性肋骨骨折管理的指南，重点指导整体治疗决策和计划；另一篇关于肋骨骨折手术治疗的临床指南缺乏肋骨骨折手术治疗的最新相关进展。中华医学会创伤学分会、中国医师协会创伤外科医师分会组织心胸外科、创伤外科、急诊外科、骨科等多学科专家共同参与，遵循循证医学原则，符合科学性和实用性，制定了《创伤性肋骨骨折手术治疗中国专家共识（2021 年版）》。该专家共识从术前影像学评估、手术适应证、手术时机、手术方法、肋骨骨折手术固定部位、内固定方法和材料选择、合并伤处理等 7 个方面提出了一些明确、适用、分级的建议，为创伤性肋骨骨折的手术治疗提供了指导和参考。
