Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany.
Department of Orthopaedics, Trauma Surgery, Reconstructive Surgery, Plastic Surgery, and Burn Medicine, Hand Surgery, German Armed Forces Central Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany.
Langenbecks Arch Surg. 2022 Dec;407(8):3681-3690. doi: 10.1007/s00423-022-02629-y. Epub 2022 Aug 10.
Traumatic diaphragmatic rupture is a rare injury in the severely injured patient and is most commonly caused by blunt mechanisms. However, penetrating mechanisms can also dominate depending on regional and local factors. Traumatic diaphragmatic rupture is difficult to diagnose and can be missed by primary diagnostic procedures in the resuscitation room. Initially not life-threatening, diaphragmatic ruptures can cause severe sequelae in the patient's long-term course if untreated. The objective of this study was to assess the epidemiology, associated injuries, and outcome of traumatic diaphragmatic ruptures based on a multicenter registry-based analysis.
Data from all patients enrolled in the TraumaRegister DGU® between 2009 and 2018 were retrospectively analyzed. That multicenter database collects data on prehospital, intra-hospital emergency, intensive care therapy, and discharge. Included were all patients with a Maximum Abbreviated Injury Scale (MAIS) score of 3 or above and patients with a MAIS score of 2 who died or were treated in the intensive care unit, for whom standard documentation forms had been completed and who had sustained a diaphragmatic rupture (AIS score of 3 or 4). The data has been analyzed using descriptive statistics and chi-square test or Mann-Whitney U test.
Of the 199,933 patients included in the study population, 687 patients (0.3%) had a diaphragmatic rupture. Of these, 71.9% were male. The mean patient age was 46.1 years. Blunt trauma accounted for 73.5% of the injuries. Primary diagnosis was established in the resuscitation room in 93.1% of the patients. Multislice helical computed tomography (MSCT) was performed in 82.7% of the cases. Rib fractures were detected in 60.7% of the patients with a diaphragmatic injury. Patients with diaphragmatic rupture had a higher mean Injury Severity Score (ISS) than patients without a diaphragmatic injury (32.9 vs. 18.6) and a higher mortality rate (13.2% vs. 9.0%).
In contrast to the literature, primary diagnostic procedures in the resuscitation room detected relevant diaphragmatic ruptures (AIS ≥ 3) in more than 90% of the patients in our study population. In addition, complex associated serial rib fractures are an important diagnostic indicator.
创伤性横膈破裂是严重创伤患者中罕见的损伤，最常见于钝性机制。然而，穿透机制也可能因区域和局部因素而占主导地位。创伤性横膈破裂很难诊断，在复苏室的初步诊断程序中可能会被遗漏。最初没有生命危险，但如果不治疗，横膈破裂可能会在患者的长期病程中造成严重的后遗症。本研究的目的是基于多中心基于登记的分析评估创伤性横膈破裂的流行病学、相关损伤和结果。
回顾性分析了 2009 年至 2018 年期间纳入 TraumaRegister DGU®的所有患者的数据。该多中心数据库收集了院前、院内急诊、重症监护治疗和出院的数据。包括所有 MAIS 评分 3 或以上的患者和 MAIS 评分 2 但死亡或在重症监护病房治疗的患者，这些患者完成了标准的记录表格，并发生了横膈破裂（AIS 评分 3 或 4）。使用描述性统计和卡方检验或曼-惠特尼 U 检验分析数据。
在研究人群中，199933 例患者中，687 例（0.3%）发生横膈破裂。其中，71.9%为男性。患者平均年龄为 46.1 岁。钝性创伤占损伤的 73.5%。93.1%的患者在复苏室建立了初步诊断。82.7%的病例进行了多层螺旋 CT（MSCT）检查。膈肌损伤患者中，肋骨骨折检出率为 60.7%。发生横膈破裂的患者的损伤严重程度评分（ISS）均值高于未发生横膈破裂的患者（32.9 比 18.6），死亡率也更高（13.2%比 9.0%）。
与文献相比，我们的研究人群中，超过 90%的患者在复苏室的初步诊断程序中发现了相关的横膈破裂（AIS≥3）。此外，复杂的连续肋骨骨折是一个重要的诊断指标。
