From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (E.T.-L., L.A., W.G., G.H., M.F., C.K., S.B., J.N., C.B., W.R., T.C., L.S., S.D.S.), University of California, Irvine, Orange, California; and Department of General Surgery, Emergency General Surgery, Trauma and Critical Care (F.M.P.), University of Colorado, School of Medicine, Aurora, Colorado.
J Trauma Acute Care Surg. 2023 Apr 1;94(4):567-572. doi: 10.1097/TA.0000000000003811. Epub 2022 Oct 25.
Intrathoracic surgical stabilization of rib fractures allows for a novel approach to rib fracture repair. This approach can help minimize muscle disruption, which may improve patient recovery compared with traditional extrathoracic plating. We hypothesized patients undergoing intrathoracic plating (ITP) to have a shorter length of stay (LOS) and intensive care unit (ICU) LOS compared with extrathoracic plating (ETP).
A prospective observational paradigm shift study was performed from November 2017 until September 2021. Patients 18 and older who underwent surgical stabilization of rib fractures were included. Patients with ahead Abbreviated Injury Scale score ≥3 were excluded. Patients undergoing ETP (July 2017 to October 2019) were compared with ITP (November 2019 to September 2021) with Pearson χ 2 tests and Mann-Whitney U tests, with the primary outcome being LOS and ICU LOS.
Ninety-six patients were included, 59 (61%) underwent ETP and 37 (38%) underwent ITP. The most common mechanism of injury was motor vehicle collision (29%) followed by falls (23%). There were no differences between groups in age, comorbidities, insurance, discharge disposition and injury severity score (18 vs. 19, p = 0.89). Intrathoracic plating had a shorter LOS (10 days vs. 8 days, p = 0.04) when compared with ETP but no difference in ICU LOS (4 days vs. 3 days, p = 0.12) and ventilator days. Extrathoracic plating patients more commonly received epidural anesthesia (56% vs. 24%, p < 0.001) and intercostal nerve block (56% vs. 29%, p = 0.01) compared with ITP. However, there was no difference in median morphine equivalents between cohorts. Operative time was shorter for ITP with ETP (279 minutes vs. 188 minutes, p < 0.001) after adjusting for numbers of ribs fixed.
In this single-center study, patients who underwent ITP had a decreased LOS and operative time in comparison to ETP in patients with similar injury severity. Future prospective multicenter research is needed to confirm these findings and may lead to further adoption of this minimally invasive technique.
Therapeutic/Care Management; Level IV.
胸腔内外科固定肋骨骨折为肋骨骨折修复提供了一种新方法。这种方法可以帮助减少肌肉的破坏，与传统的胸腔外板固定相比，这可能会促进患者的康复。我们假设与胸腔外板固定（ETP）相比，接受胸腔内板固定（ITP）的患者住院时间（LOS）和重症监护病房（ICU） LOS 更短。
从 2017 年 11 月至 2021 年 9 月进行了一项前瞻性观察范式转变研究。纳入了接受手术固定肋骨骨折的 18 岁及以上患者。排除头部简明损伤评分≥3 的患者。将 2017 年 7 月至 2019 年 10 月接受 ETP 的患者与 2019 年 11 月至 2021 年 9 月接受 ITP 的患者进行比较，采用 Pearson χ 2 检验和 Mann-Whitney U 检验，主要结局是 LOS 和 ICU LOS。
共纳入 96 例患者，59 例（61%）接受 ETP，37 例（38%）接受 ITP。最常见的损伤机制是机动车碰撞（29%），其次是跌倒（23%）。两组在年龄、合并症、保险、出院去向和损伤严重程度评分方面无差异（18 分比 19 分，p = 0.89）。ITP 的 LOS 比 ETP 更短（10 天比 8 天，p = 0.04），但 ICU LOS（4 天比 3 天，p = 0.12）和呼吸机使用天数无差异。与 ITP 相比，ETP 患者更常接受硬膜外麻醉（56%比 24%，p < 0.001）和肋间神经阻滞（56%比 29%，p = 0.01）。然而，两组之间的吗啡等效中位数没有差异。调整固定肋骨数量后，ITP 的手术时间比 ETP 更短（279 分钟比 188 分钟，p < 0.001）。
在这项单中心研究中，与 ETP 相比，损伤严重程度相似的患者接受 ITP 治疗时，住院时间和手术时间更短。需要进一步开展前瞻性多中心研究来证实这些发现，并可能导致这种微创技术的进一步应用。
治疗/护理管理；四级。
