Schmelzer Katharina, Ziegenhain Franziska, Canal Claudio, Pape Hans-Christoph, Neuhaus Valentin
Chirurgische Klinik, Kantonsspital Glarus (KSGL), Burgstr. 99, 8750, Glarus, Schweiz.
Klinik für Traumatologie, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistr. 100, 8091, Zürich, Schweiz.
Chirurgie (Heidelb). 2023 Sep;94(9):789-795. doi: 10.1007/s00104-023-01891-0. Epub 2023 Jun 2.
Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and managing resources in thoracic trauma.
The aim of the study was to analyze concomitant injuries in unilateral and bilateral rib fractures and pulmonary contusions and evaluate differences in complication rates between the two.
In a retrospective study, data from all patients diagnosed with thoracic trauma at a level I trauma center were analyzed. Bivariate and multivariate analysis were used to examine an association of unilateral or bilateral rib fractures, serial rib fractures, and pulmonary contusions with multiple injuries and outcomes. In addition, multivariate regression analysis was utilized to determine the impact of age, gender and additional injuries on outcome.
A total of 714 patients were included in the analysis. The mean Injury Severity Score (ISS) was 19. Patients with an additional thoracic spine injury had a significantly higher incidence of bilateral rib fractures. Pulmonary contusions were associated with younger age. Abdominal injuries were predictors for bilateral pulmonary contusions. Complications occurred in 36% of the patients. Bilateral injuries increased the complication rate up to 70%. Pelvic and abdominal injuries as well as the need for a chest drain were significant risk factors for complications. The mortality rate was 10%, with higher age, head and pelvic injuries as predictors.
Patients with bilateral chest trauma had an increased incidence of complications and a higher mortality rate. Bilateral injuries and significant risk factors must therefore be considered. Injury of the thoracic spine should be excluded in those patients.
胸部创伤的发病率和死亡率都很高。评估并发症风险对于制定进一步的治疗策略和管理胸部创伤资源至关重要。
本研究旨在分析单侧和双侧肋骨骨折及肺挫伤中的合并伤，并评估两者并发症发生率的差异。
在一项回顾性研究中，分析了一级创伤中心所有诊断为胸部创伤患者的数据。采用双变量和多变量分析来研究单侧或双侧肋骨骨折、连续性肋骨骨折以及肺挫伤与多发伤和预后之间的关联。此外，利用多变量回归分析来确定年龄、性别和其他损伤对预后的影响。
共有714例患者纳入分析。平均损伤严重程度评分（ISS）为19分。合并胸椎损伤的患者双侧肋骨骨折的发生率显著更高。肺挫伤与较年轻的年龄相关。腹部损伤是双侧肺挫伤的预测因素。36%的患者发生了并发症。双侧损伤使并发症发生率增至70%。骨盆和腹部损伤以及需要放置胸腔引流管是并发症的显著危险因素。死亡率为10%，年龄较大、头部和骨盆损伤是死亡的预测因素。
双侧胸部创伤患者的并发症发生率增加，死亡率更高。因此，必须考虑双侧损伤和显著的危险因素。这些患者应排除胸椎损伤。
