胸骨固定对患者结局的影响：病例匹配回顾。

Impact of sternal fixation on patient outcomes: A case matched review.

机构信息

From the Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.

出版信息

J Trauma Acute Care Surg. 2023 Apr 1;94(4):573-577. doi: 10.1097/TA.0000000000003824. Epub 2022 Oct 31.

DOI:10.1097/TA.0000000000003824

PMID:36730841

Abstract

INTRODUCTION

Sternal fractures are debilitating injuries often resulting in severe pain and respiratory compromise. Surgical fixation of sternal fractures is gaining popularity as a treatment modality for sternal fractures. Unfortunately, little literature exists on this topic. This study looks to further examine the benefits of sternal fixation (SF), hypothesizing SF results in improved pain, improved respiratory function, and decreased opioid use.

METHODS

Retrospective review was performed between patients with sternal fractures who underwent nonoperative management (NOM) versus operative SF. Case matching was used to construct an artificial control group matched on age and Injury Severity Score using a 1:1 ratio of treatment to control. Exclusion criteria were age younger than 18 years. Outcomes of interest included mean pain score, total opioid requirements (in morphine milliequivalents) within 24 hours of discharge, intensive care unit and hospital length of stay (LOS), and incentive spirometry percent predicted value at discharge. Dependent variables were analyzed using t test, and Injury Severity Score was analyzed using the sign test. Statistical significance was set at p < 0.05.

RESULTS

Fifty-eight patients from the SF cohort were matched with 58 patients from the NOM cohort. The average age was 59.8 years for the SF group and 62.2 years for the NOM group. Injury Severity Score was matched at 9 for both cohorts. Although pain scores were similar for both cohorts, the SF group required significantly less opioids at discharge (62.1 vs. 92.2 morphine milliequivalents; p = 0.007). In addition, the SF cohort demonstrated significantly improved respiratory function per incentive spirometry percent predicted value at discharge (75.5% vs. 59.9%; p < 0.001). Intensive care unit LOS and hospital LOS were similar between cohorts.

CONCLUSION

Despite similarities in pain scores, intensive care unit LOS, and hospital LOS, SF was associated with decreased opioid requirements and improved respiratory function at discharge in this study.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.

摘要

简介

胸骨骨折是一种使人虚弱的损伤，常导致严重疼痛和呼吸功能受损。胸骨骨折的手术固定作为胸骨骨折的一种治疗方法越来越受到关注。不幸的是，关于这个话题的文献很少。本研究进一步探讨了胸骨固定（SF）的益处，假设 SF 可改善疼痛、改善呼吸功能和减少阿片类药物的使用。

方法

对接受非手术治疗（NOM）与手术 SF 治疗的胸骨骨折患者进行回顾性研究。采用病例匹配的方法，按年龄和损伤严重度评分（ISS）以 1:1 的比例构建人工对照组进行治疗。排除标准为年龄小于 18 岁。感兴趣的结果包括平均疼痛评分、出院后 24 小时内的总阿片类药物需求量（以吗啡毫当量计）、重症监护病房和住院时间（LOS）以及出院时激励肺活量预测值。使用 t 检验分析因变量，使用符号检验分析损伤严重度评分。统计学意义设定为 p<0.05。

结果

SF 组有 58 例患者与 NOM 组的 58 例患者匹配。SF 组的平均年龄为 59.8 岁，NOM 组的平均年龄为 62.2 岁。两组的损伤严重度评分均为 9 分。尽管两组的疼痛评分相似，但 SF 组出院时的阿片类药物需求量明显较少（62.1 对 92.2 吗啡毫当量；p=0.007）。此外，SF 组在出院时的激励肺活量预测值百分比显示出明显改善的呼吸功能（75.5%对 59.9%；p<0.001）。两组的重症监护病房 LOS 和住院 LOS 相似。