Division of Trauma, Emergency General Surgery, Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):3299-3304. doi: 10.1007/s00068-022-01900-7. Epub 2022 Feb 25.
Surgical stabilization of rib fractures (SSRF) has been gaining popularity for the treatment of rib fractures. Limited literature exists regarding the long-term effects of SSRF versus non-operative (NO) intervention. The goal of this study is to better understand these long-term effects, hypothesizing SSRF patients have better outcomes.
IRB approved survey study at our Level I trauma center. Patients suffering rib fractures from 1/2017 through 1/2019 were surveyed via phone call and asked five questions. Basic demographics obtained. The five survey questions asked: "Are you still experiencing pain from your rib fractures?"; "If yes, how would you rate your pain 1-10?"; "Are you back to your baseline activity level?"; "If no, is this related to your rib fractures?"; "Do you feel your rib fractures moving/clicking?" Paired t test, Chi square, and median tests were utilized. Significance was set at p < 0.05.
527 patients were called with 228 unsuccessfully reached. 47 refused to participate. 252 patients (47.8%) participated in the survey; 78 SSRF and 174 NO. Age and gender were similar between cohorts. Majority of patients suffered blunt trauma. No significant difference between ISS; 15 SSRF vs 14 NO. SSRF patients had worse chest trauma with median chest AIS of 3 (IQR 3-4) vs 3 (IQR 3-3) for NO (p < 0.001). Response to survey questions revealed similar incidences of pain between SSRF and NO cohorts (28.2% vs 27.6%; p = 0.939), however decreased pain scores for SSRF group (2 vs 4; p = 0.006). Return to baseline activity was better for the SSRF group (75.6% vs 56.3%; p = 0.143) and the incidence of rib fractures being the reason for patients not returning to baseline was decreased (26.3% vs 44.7%; p = 0.380). Lastly, SSRF resulted in significantly less movement of rib fractures (3.8% vs 13.8%; p = 0.031).
Patients who undergo SSRF show significant long-term improvements in pain scores and better return to baseline function with less overall issues from their rib fractures compared to those managed non-operatively.
外科固定肋骨骨折（SSRF）在肋骨骨折治疗中越来越受欢迎。关于 SSRF 与非手术（NO）干预的长期效果的文献有限。本研究的目的是更好地了解这些长期影响，并假设 SSRF 患者的治疗效果更好。
在我们的一级创伤中心进行了 IRB 批准的调查研究。通过电话调查了 2017 年 1 月至 2019 年 1 月期间因肋骨骨折而就诊的患者，并询问了五个问题。获得了基本人口统计学资料。五个调查问题是：“您仍因肋骨骨折而感到疼痛吗？”；“如果是，您会将疼痛程度评为 1-10 级？”；“您是否恢复到基线活动水平？”；“如果没有，这与您的肋骨骨折有关吗？”；“您是否感觉到肋骨骨折在移动/咔嗒作响？”。使用配对 t 检验，卡方检验和中位数检验。显著性设置为 p < 0.05。
共呼叫了 527 名患者，但有 228 名未接通。47 人拒绝参加。252 名患者（47.8％）参加了调查；78 例 SSRF 和 174 例 NO。两组的年龄和性别相似。大多数患者遭受钝性创伤。ISS 之间无显着差异；15 SSRF 与 14 NO。SSRF 患者的胸部创伤更严重，中位数胸部 AIS 为 3（IQR 3-4），而 NO 为 3（IQR 3-3）（p < 0.001）。对调查问题的答复表明，SSRF 和 NO 队列之间疼痛的发生率相似（28.2％对 27.6％； p = 0.939），但是 SSRF 组的疼痛评分较低（2 对 4； p = 0.006）。SSR 组的基线活动恢复更好（75.6％对 56.3％； p = 0.143），并且由于肋骨骨折而无法恢复到基线的患者的发生率降低（26.3％对 44.7％； p = 0.380）。最后，SSRF 导致肋骨骨折的活动明显减少（3.8％对 13.8％； p = 0.031）。
与接受非手术治疗的患者相比，接受 SSRF 治疗的患者在疼痛评分和更好地恢复基线功能方面具有明显的长期改善，并且总体上肋骨骨折的问题较少。
