Adult Critical care Unit, The Royal London hospital, Barts Health NHS Trust, United Kingdom.
Centre for trauma sciences, Queen Mary University London, United Kingdom.
Injury. 2022 Sep;53(9):2947-2952. doi: 10.1016/j.injury.2022.04.020. Epub 2022 Apr 25.
Severe chest injuries are associated with significant morbidity and mortality. Surgical rib fixation has become a more commonplace procedure to improve chest wall mechanics, pain, and function. The aim of this study was to characterise the epidemiology and long-term functional outcomes of chest trauma patients who underwent rib fixation in a major trauma centre (MTC).
This was a retrospective review (2014-19) of all adult patients with significant chest injury who had rib fixation surgery following blunt trauma to the chest. The primary outcome was functional recovery after hospital discharge, and secondary outcomes included length of intensive care unit (ICU) and hospital stay, maximum organ support, tracheostomy insertion, ventilator days.
60 patients underwent rib fixation. Patients were mainly male (82%) with median age 52 (range 24-83) years, injury severity score (ISS) of 29 (21-38), 10 (4-19) broken ribs, and flail segment in 90% of patients. Forty-six patients (77%) had a good outcome (GOSE grade 6-8). Patients in the poor outcome group (23%; GOSE 1-5) tended to be older [55 (39-83) years vs. 51 (24-78); p = 0.05] and had longer length of hospital stay [42 (19-82) days vs. 24 (7-90); p<0.01]. Injury severity, rate of mechanical ventilation or organ dysfunction did not affect long term outcome. Nineteen patients (32%) were not mechanically ventilated.
Rib fixation was associated with good long-term outcomes in severely injured patients. Age was the only predictor of long-term outcome. The results suggest that rib fixation be considered in patients with severe chest injuries and may also benefit those who are not mechanically ventilated but are at risk of deterioration.
严重胸部损伤与显著的发病率和死亡率相关。外科肋骨固定术已成为改善胸壁力学、疼痛和功能的更为常见的手术。本研究的目的是描述在大型创伤中心（MTC）接受肋骨固定术的胸部创伤患者的流行病学和长期功能结果。
这是一项对所有因钝性胸部创伤后接受肋骨固定术的成年严重胸部损伤患者的回顾性研究（2014-19 年）。主要结局是出院后的功能恢复，次要结局包括重症监护病房（ICU）和住院时间、最大器官支持、气管切开术插入、呼吸机使用天数。
60 例患者接受了肋骨固定术。患者主要为男性（82%），中位年龄 52 岁（范围 24-83 岁），损伤严重程度评分（ISS）为 29（21-38），10 根（4-19 根）肋骨骨折，90%的患者为连枷胸。46 例（77%）患者预后良好（GOSE 评分 6-8）。预后不良组（23%；GOSE 评分 1-5）的患者年龄较大[55（39-83）岁比 51（24-78）岁；p=0.05]，住院时间较长[42（19-82）天比 24（7-90）天；p<0.01]。损伤严重程度、机械通气或器官功能障碍的发生率并不影响长期预后。19 例（32%）患者无需机械通气。
肋骨固定术与严重损伤患者的长期良好结局相关。年龄是长期预后的唯一预测因素。结果表明，肋骨固定术应考虑用于严重胸部损伤患者，对于那些无需机械通气但有恶化风险的患者也可能有益。
