Trauma Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
Royal Brisbane and Women's Hospital, Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
Arch Orthop Trauma Surg. 2023 Nov;143(11):6561-6567. doi: 10.1007/s00402-023-04952-5. Epub 2023 Jul 4.
The objective of this study was to determine if operative fixation of clavicle fractures in patients with non-operatively treated ipsilateral rib fractures is associated with a lower overall analgesic requirement and improved respiratory function.
A retrospective matched cohort study was conducted involving patients admitted to a single tertiary trauma centre having sustained a clavicle fracture with ipsilateral rib fracture/s between January 2014 and June 2020. Patients were excluded if brain, abdominal, pelvic, or lower limb trauma was identified. 31 patients with operative clavicle fixation (study group) were matched 1:1 to 31 patients with non-operative management of the clavicle fracture (control group) based on age, sex, number of rib fractures and injury severity score. The primary outcome was the number of analgesic types used, and the secondary outcome was respiratory function.
The study group required a mean of 3.50 types of analgesia prior to surgery which decreased to 1.57 post-surgery. The control group required 2.92 types of analgesia, reducing to 1.65 after the date of surgery in the study group. A General Linear Mixed Model indicated that the intervention (operative vs. non-operative management) had statistically significant effects on the number of required analgesic types (p < 0.001, [Formula: see text] = 0.365), oxygen saturation (p = 0.001, [Formula: see text] = 0.341, 95% CI 0.153-0.529) and temporal decline in daily supplemental oxygen requirement (p < 0.001, [Formula: see text] = 0.626, 95% CI 0.455-0.756).
This study supported the hypothesis that operative clavicle fixation reduces short-term in-patient analgesia use and improves respiratory parameters in patients with ipsilateral rib fractures.
Level III therapeutic study.
本研究旨在确定在同侧肋骨骨折经非手术治疗的患者中，锁骨骨折的手术固定是否与总体镇痛需求降低和呼吸功能改善相关。
对 2014 年 1 月至 2020 年 6 月期间在一家三级创伤中心接受锁骨骨折合并同侧肋骨骨折/骨折的患者进行了回顾性匹配队列研究。如果发现颅脑、腹部、骨盆或下肢创伤，则排除患者。根据年龄、性别、肋骨骨折数量和损伤严重程度评分，将 31 例接受手术锁骨固定的患者（研究组）与 31 例接受非手术治疗的锁骨骨折患者（对照组）进行 1:1 匹配。主要结局是使用的镇痛类型数量，次要结局是呼吸功能。
研究组在手术前需要平均 3.50 种镇痛类型，手术后减少至 1.57 种。对照组在手术前需要 2.92 种镇痛类型，手术后减少至 1.65 种。一般线性混合模型表明，干预措施（手术与非手术治疗）对所需镇痛类型的数量具有统计学显著影响（p<0.001，[Formula: see text] = 0.365），氧饱和度（p=0.001，[Formula: see text] = 0.341，95%CI 0.153-0.529）和每日补充氧气需求的时间下降（p<0.001，[Formula: see text] = 0.626，95%CI 0.455-0.756）。
本研究支持以下假设，即锁骨骨折的手术固定可减少同侧肋骨骨折患者的短期住院镇痛需求并改善呼吸参数。
III 级治疗研究。
