Adereti Christopher, Fabien Jamesa, Adereti Jeanette, Pierre-Louis Muller, Chacon Daniel, Adereti Vincent
Surgery, Ross University School of Medicine, Bridgetown, BRB.
Medicine, Ross University, Bridgetown, BRB.
Cureus. 2022 Sep 27;14(9):e29664. doi: 10.7759/cureus.29664. eCollection 2022 Sep.
Timely repair is essential to maximizing outcomes in patients with traumatic rib injuries, whether in the presence or absence of flail chest (FC) or existing as single or multiple rib fractures (MRF), due to its high morbidity and mortality rate. This review focuses primarily on the plating system as an effective surgical approach to stabilizing these injuries. Literature was surveyed using the Google Scholar, PLOS One, and PubMed search engines between August 2021 and April 2022. A total of 34 articles were included herein, and primary and secondary outcomes were assessed. The primary outcomes of interest were intensive care unit length-of-stay (ICU LOS), hospital length-of-stay (HLOS), ventilatory requirements, and mortality rate. The secondary outcomes of interest were postoperative pain level and postoperative complications. The majority of the studies included herein reported lower ICU LOS, HLOS, and ventilation requirements in surgical patients when compared to conservatively managed patients. However, variables such as the presence or absence of FC also impacted outcomes in certain studies. Mortality rate and postoperative pain were largely underreported in the selected studies, but limited data from these studies suggest that these outcomes tend to be lower in surgical patients compared to those treated conservatively. When present, postoperative complications were often less severe amongst surgical patients compared to conservatively managed patients. Results further suggest that surgical repair is associated with lower pain severity as early as 72 hours postop. Likewise, findings suggest that early rib fracture stabilization is superior to late stabilization and often yields a sooner return to a baseline health status. Few studies report little to no statistical difference in primary and secondary outcomes between operative and conservative treatment. However, there is greater evidence that suggests the contrary, with better short-term and potential for better long-term outcomes in patients who undergo rib fixation.
由于创伤性肋骨损伤患者的发病率和死亡率较高，无论是否存在连枷胸（FC），或表现为单根或多根肋骨骨折（MRF），及时修复对于实现最佳治疗效果至关重要。本综述主要关注钢板固定系统，这是一种稳定这些损伤的有效手术方法。在2021年8月至2022年4月期间，使用谷歌学术、公共科学图书馆·综合（PLOS One）和医学期刊数据库（PubMed）搜索引擎对文献进行了检索。本文共纳入34篇文章，并对主要和次要结果进行了评估。感兴趣的主要结果是重症监护病房住院时间（ICU LOS）、医院住院时间（HLOS）、通气需求和死亡率。感兴趣的次要结果是术后疼痛程度和术后并发症。本文纳入的大多数研究报告称，与保守治疗的患者相比，手术患者的ICU LOS、HLOS和通气需求更低。然而，在某些研究中，是否存在FC等变量也会影响治疗结果。在所选择的研究中，死亡率和术后疼痛大多报告不足，但这些研究的有限数据表明，与保守治疗的患者相比，手术患者的这些结果往往更低。当出现术后并发症时，与保守治疗的患者相比，手术患者的并发症通常不那么严重。结果进一步表明，手术修复早在术后72小时就与较低的疼痛严重程度相关。同样，研究结果表明，早期肋骨骨折固定优于晚期固定，并且通常能更快恢复到基线健康状态。很少有研究报告手术治疗和保守治疗在主要和次要结果上几乎没有统计学差异。然而，有更多证据表明情况恰恰相反，肋骨固定患者的短期效果更好，长期效果也可能更好。
