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手术时机是否会影响中青年行手术固定肋骨骨折患者的结局?反馈意见基于医生、患者和家属照护者的真实数据。

Does the timing of surgery affect outcomes in young and middle-aged patients undergoing surgical stabilization of rib fractures? Feedback was based on real data from physicians, patients, and family caregivers.

机构信息

Department of Thoracic Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, Shaanxi, China.

出版信息

Eur J Trauma Emerg Surg. 2023 Dec;49(6):2467-2477. doi: 10.1007/s00068-023-02321-w. Epub 2023 Jul 12.

Abstract

BACKGROUND

There is a general clinical consensus that early surgical stabilization of rib fractures (SSRF, ≤ 48-72 h after admission) can benefit patients, and this is only regarding the surgeon's opinions. This study assessed the true outcomes of young and middle-aged patients at different surgical timings.

METHODS

This retrospective cohort study was conducted among patients aged 30-55 years who were hospitalized with a diagnosis of isolated rib fractures and underwent SSRF between July 2017 and September 2021. The patients were divided into early (≤ 3 days), mid- (4-7 days) and late (8-14 days) groups, according to the interval (days) between surgery and injury date. The impact of different surgical timings on clinical outcomes, patients, and families was assessed by comparing SSRF-related data during hospitalization and follow-up studies of clinicians, patients themselves, and family caregivers 1-2 months after surgery.

RESULTS

In this study, 155 complete patient data were finally included, including 52, 64, and 39 patients in the early, mid, and late groups, respectively. Length of operation, preoperative closed chest drainage rate, length of hospital stay, intensive care unit length of stay, duration of invasive mechanical ventilation in the early group were lower than those in the intermediate and late groups. Additionally, hemothorax and excess pleural fluid incidence after SSRF was lower in the early group than in the intermediate and late groups. Postoperative follow-up results showed that patients in the early group had higher SF-12 physical component summary scores and shorter duration of absence from work. Family caregivers had lower Zarit Burden Interview scores than those in the mid- and late groups.

CONCLUSION

From the experience of our institution's SSRF, early surgery is safe and offers additional potential benefits for young and middle-aged patients and families with isolated rib fractures.

摘要

背景

普遍的临床共识认为,早期进行肋骨骨折手术固定(SSRF,入院后 48-72 小时内)对患者有益,这只是外科医生的观点。本研究评估了不同手术时机下年轻和中年患者的真实结局。

方法

本回顾性队列研究纳入了 2017 年 7 月至 2021 年 9 月期间因单纯肋骨骨折住院并接受 SSRF 的 30-55 岁患者。根据手术与受伤日期之间的间隔(天),患者被分为早期(≤3 天)、中期(4-7 天)和晚期(8-14 天)组。通过比较住院期间的 SSRF 相关数据以及术后 1-2 个月临床医生、患者自身和家庭照顾者的随访研究,评估不同手术时机对临床结局、患者和家庭的影响。

结果

本研究最终纳入了 155 例完整的患者数据,其中早期、中期和晚期组分别有 52、64 和 39 例患者。手术时间、术前闭式胸腔引流率、住院时间、重症监护病房住院时间、有创机械通气时间在早期组均低于中晚期组。此外,早期组 SSRF 后血胸和胸腔积液过多的发生率低于中晚期组。术后随访结果显示,早期组患者的 SF-12 生理成分综合评分更高,旷工时间更短。家庭照顾者的 Zarit 负担访谈评分低于中晚期组。

结论

根据我们机构 SSRF 的经验,早期手术是安全的,可为年轻和中年患者以及单纯肋骨骨折患者及其家庭带来额外的潜在益处。

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