钛板治疗连枷胸的手术和围手术期管理：法国胸科转诊中心的队列研究。

Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center.

机构信息

Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Médecine Intensive Réanimation, Sorbonne Université, 75020, Paris, France.

Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Péri-operatoire, Sorbonne Université, 75020, Paris, France.

出版信息

J Cardiothorac Surg. 2023 Jan 18;18(1):37. doi: 10.1186/s13019-023-02121-8.

DOI:10.1186/s13019-023-02121-8

PMID:36653803

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9850677/

Abstract

BACKGROUND

The development of titanium claw plates has made rib osteosynthesis easy to achieve and led to a renewed interest for this surgery. We report the management of patients referred to the intensive care unit (ICU) of a referral center for surgical rib fracture fixation (SRFF) after chest trauma.

METHODS

We performed a retrospective observational cohort study describing the patients' characteristics and analyzing the determinants of postoperative complications.

RESULTS

From November 2013 to December 2016, 42 patients were referred to our center for SRFF: 12 patients (29%) had acute respiratory failure, 6 of whom received invasive mechanical ventilation. The Thoracic Trauma Severity Score (TTSS) was 11.0 [9-12], with 7 [5-9] broken ribs and a flail chest in 92% of cases. A postoperative complication occurred in 18 patients (43%). Five patients developed ARDS (12%). Postoperative pneumonia occurred in 11 patients (26%). Two patients died in the ICU. In multivariable analysis, the Thoracic Trauma Severity Score (TTSS) (OR = 1.89; CI 95% 1.12-3.17; p = 0.016) and the Simplified Acute Physiology Score II without age (OR = 1.17; CI 95% 1.02-1.34; p = 0.024) were independently associated with the occurrence of a postoperative complication.

CONCLUSION

The TTSS score appears to be accurate for determining thoracic trauma severity. Short and long-term benefit of Surgical Rib Fracture Fixation should be assessed, particularly in non-mechanically ventilated patients.

摘要

背景

钛制爪板的发展使得肋骨骨折内固定变得容易实现，并重新引起了人们对这种手术的兴趣。我们报告了转诊至外科肋骨骨折内固定（SRFF）治疗中心的创伤后入住重症监护病房（ICU）患者的治疗情况。

方法

我们进行了一项回顾性观察性队列研究，描述了患者的特征，并分析了术后并发症的决定因素。

结果

2013 年 11 月至 2016 年 12 月期间，共有 42 例患者转诊至我院进行 SRFF：12 例（29%）发生急性呼吸衰竭，其中 6 例接受了有创机械通气。胸外伤严重程度评分（TTSS）为 11.0[9-12]分，7 例（5-9）根肋骨骨折，92%的患者为连枷胸。18 例（43%）患者术后出现并发症。5 例患者发生 ARDS（12%）。11 例患者发生术后肺炎。2 例患者在 ICU 死亡。多变量分析显示，胸外伤严重程度评分（TTSS）（OR=1.89；95%CI 1.12-3.17；p=0.016）和简化急性生理学评分 II 且无年龄因素（OR=1.17；95%CI 1.02-1.34；p=0.024）与术后并发症的发生独立相关。