From the Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, England.
J Trauma Acute Care Surg. 2023 Dec 1;95(6):839-845. doi: 10.1097/TA.0000000000004068. Epub 2023 Aug 3.
Costal margin rupture (CMR) injuries are under-diagnosed and inconsistently managed, while carrying significant symptomatic burden. We hypothesized that the Sheffield Classification system of CMR injuries would relate to injury patterns and management options.
Data were collected prospectively between 2006 and 2023 at a major trauma center in the United Kingdom. Computed tomography scans were interrogated and injuries were categorized according to the Sheffield Classification. Clinical, radiologic, management and outcome variables were assessed.
Fifty-four patients were included in the study. Intercostal hernia (IH) was present in 30 patients and associated with delayed presentation ( p = 0.004), expulsive mechanism of injury (i.e. such as occurs with coughing, sneezing, or retching), higher body mass index ( p < 0.001), and surgical management ( p = 0.02). There was a bimodal distribution of the level of the costal margin rupture, with IH Present and expulsive mechanism injuries occurring predominantly at the ninth costal cartilage, and IH Absent cases and other mechanisms at the seventh costal cartilage ( p < 0.001). There were correlations between the costal cartilage being thin at the site of the CMR and the presence of IH and expulsive etiology ( p < 0.001). Management was conservative in 23 and surgical in 31 cases. Extrathoracic mesh IH repairs were performed in 3, Double Layer Mesh Repairs in 8, Suture IH repairs in 5, CMR plating in 8, CMR sutures in 2, and associated Surgical Stabilization of Rib Fractures in 11 patients. There was one postoperative death. There were seven repeat surgical procedures in five patients.
The Sheffield Classification is associated statistically with presentation, related chest wall injury patterns, and type of definitive management. Further collaborative data collection is required to determine the optimal management strategies.
Therapeutic/Care Management; Level III.
肋缘断裂（CMR）损伤的诊断不足且治疗方法不一致，同时伴有明显的症状负担。我们假设谢菲尔德分类系统（Sheffield Classification system）的 CMR 损伤与损伤模式和管理选择有关。
本研究在英国一家大型创伤中心前瞻性地收集了 2006 年至 2023 年的数据。通过计算机断层扫描（CT）扫描来分析损伤，并根据谢菲尔德分类进行分类。评估了临床、影像学、管理和结局变量。
本研究共纳入 54 例患者。30 例患者存在肋间隙疝（IH），与迟发性表现（p = 0.004）、呼气性损伤机制（如咳嗽、打喷嚏或呕吐时发生）、较高的体重指数（p < 0.001）和手术治疗（p = 0.02）有关。CMR 的肋缘断裂水平呈双峰分布，IH 存在且呼气性损伤机制的损伤主要发生在第 9 肋软骨，而 IH 不存在且其他机制的损伤主要发生在第 7 肋软骨（p < 0.001）。CMR 部位肋软骨变薄与 IH 的存在和呼气性病因之间存在相关性（p < 0.001）。23 例患者接受保守治疗，31 例患者接受手术治疗。3 例患者行胸外网片 IH 修补术，8 例行双层网片修补术，5 例行 IH 缝合修补术，8 例行 CMR 钢板固定术，2 例行 CMR 缝合术，11 例行肋骨骨折外科稳定术。术后死亡 1 例。5 例患者中有 7 例再次行手术。
谢菲尔德分类系统与表现、相关胸壁损伤模式和确定性治疗类型有统计学关联。需要进一步收集协作数据以确定最佳管理策略。
治疗/护理管理；III 级。
