Rehme-Röhrl Julia, Sicklinger Korbinian, Brand Andreas, Fürmetz Julian, Neuerburg Carl, Stuby Fabian, von Rüden Christian
Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany.
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, Ludwig-Maximilians University Munich, 81377 Munich, Germany.
J Clin Med. 2023 Jul 25;12(15):4878. doi: 10.3390/jcm12154878.
Severe thoracic trauma can lead to pulmonary restriction, loss of lung volume, and difficulty with ventilation. In recent years, there has been increasing evidence of better clinical outcomes following surgical stabilization of clavicle fractures in the setting of this combination of injuries. The aim of this study was to evaluate surgical versus non-surgical treatment of clavicle fractures in severe thoracic trauma in terms of clinical and radiological outcomes in order to make a generalized treatment recommendation based on the results of a large patient cohort.
This retrospective study included 181 patients (42 women, 139 men) from a European level I trauma centre with a median of 49.3 years in between 2005 and 2021. In 116 cases, the clavicle fracture was stabilized with locking plate or hook plate fixation (group 1), and in 65 cases, it was treated non-surgically (group 2). Long-term functional outcomes at least one year postoperatively using the disabilities of the arm, shoulder and hand (DASH) questionnaire and the Nottingham Clavicle Score (NCS) as well as radiological outcomes were collected in addition to parameters such as hospital days, intensive care days, and complication rates.
The Injury Severity Score (ISS) was 17.8 ± 9.8 in group 1 and 19.9 ± 14.4 in group 2 (mean ± SEM; = 0.93), the time in hospital was 21.5 ± 27.2 days in group 1 versus 16 ± 29.3 days in group 2 ( = 0.04). Forty-seven patients in group 1 and eleven patients in the group 2 were treated in the ICU. Regarding the duration of ventilation (group 1: 9.1 ± 8.9 days, group 2: 8.1 ± 7.7 days; = 0.64), the functional outcome (DASH group 1: 11 ± 18 points, group 2: 13.7 ± 18. 4 points, = 0.51; NCS group 1: 17.9 ± 8.1 points, group 2: 19.4 ± 10.3 points, = 0.79) and the radiological results, no significant differences were found between the treatment groups. With an overall similar complication rate, pneumonia was found in 2% of patients in group 1 and in 14% of patients in group 2 ( = 0.001).
This study could demonstrate that surgical locking plate fixation of clavicle fractures in combination with CWI significantly reducing the development of posttraumatic pneumonia in a large patient collection and, therefore, can be recommended as standard therapeutic approach for severe thoracic trauma.
严重胸部创伤可导致肺功能受限、肺容积丧失及通气困难。近年来，越来越多的证据表明，在合并此类损伤的情况下，锁骨骨折手术固定后的临床疗效更佳。本研究旨在评估严重胸部创伤中锁骨骨折的手术治疗与非手术治疗在临床和影像学方面的疗效，以便根据大量患者队列的结果给出通用的治疗建议。
这项回顾性研究纳入了2005年至2021年间来自欧洲一级创伤中心的181例患者（42例女性，139例男性），中位年龄49.3岁。116例患者采用锁定钢板或钩钢板固定锁骨骨折（第1组），65例患者采用非手术治疗（第2组）。除了收集住院天数、重症监护天数和并发症发生率等参数外，还使用手臂、肩部和手部功能障碍（DASH）问卷和诺丁汉锁骨评分（NCS）收集术后至少一年的长期功能结局以及影像学结局。
第1组的损伤严重程度评分（ISS）为17.8±9.8，第2组为19.9±14.4（均值±标准误；P = 0.93），第1组的住院时间为21.5±27.2天，第2组为16±29.3天（P = 0.04）。第1组有47例患者和第2组有11例患者在重症监护室接受治疗。关于通气时间（第1组：9.1±8.9天，第2组：8.1±7.7天；P = 0.64）、功能结局（DASH评分第1组：11±18分，第2组：13.7±18.4分，P = 0.51；NCS评分第1组：17.9±8.1分，第2组：19.4±10.3分，P = 0.79）和影像学结果，两组之间未发现显著差异。总体并发症发生率相似，第1组2%的患者和第2组14%的患者发生了肺炎（P = 0.001）。
本研究表明，在大量患者中，锁骨骨折手术锁定钢板固定联合胸壁内固定术可显著降低创伤后肺炎的发生率，因此可推荐作为严重胸部创伤的标准治疗方法。
