Zhang Dong, Wang Langran, Xi Siqi, Li Run, Jiao Chenbo, Zhang Qiang
Department of Thoracic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
The Fourth Clinical Medical College, Health Science Center of Peking University, Beijing, China.
J Thorac Dis. 2023 Aug 31;15(8):4324-4336. doi: 10.21037/jtd-22-1829. Epub 2023 Aug 1.
The treatment of simple rib fractures in older adults can be divided into surgical treatment and nonsurgical treatment, with indications for surgery presently being unclear. This study was conducted to determine whether older adult individuals with simple multiple rib fractures can benefit from surgical treatment.
A single-center, retrospective study was conducted. All 880 registry-identified patients aged ≥60 years who were admitted to Beijing Jishuitan Hospital with blunt rib fractures between 2013 to 2020 were included. They were divided into 2 groups according to whether internal fixation was performed. After screening of inclusion and exclusion criteria and propensity score matching, there were 226 patients, 113 of whom were placed in the operation group and 113 in the nonoperation group. The demographic characteristics, underlying diseases, number of rib fractures, hospital stay, intensive care unit (ICU) hospital stay, mechanical ventilation duration, fracture comorbidities on admission, pain index, and fracture healing condition were analyzed using chi-squared test and independent samples t test.
The pain score and fracture healing time were significantly improved in the operation group (P<0.05), while the duration of painkiller use was significantly shorter in the operation group (P=0.009). However, there was no significant differences in mortality, the incidence of bone nonunion, length of stay in the ICU, or duration of mechanical ventilation between the 2 groups.
For patients in the clinical study, internal fixation surgery could reduce fracture healing time and minimize the use of painkillers. Surgical treatment was determined to be safe, as it did not increase the mortality of the older adult patients. For older patients with simple rib fractures who have no contraindications to surgery, internal fixation surgery is recommended.
老年人单纯肋骨骨折的治疗可分为手术治疗和非手术治疗，目前手术指征尚不清楚。本研究旨在确定患有单纯多发性肋骨骨折的老年个体是否能从手术治疗中获益。
进行了一项单中心回顾性研究。纳入2013年至2020年间在北京积水潭医院因钝性肋骨骨折入院的所有880例登记确诊的年龄≥60岁的患者。根据是否进行内固定将他们分为两组。在筛选纳入和排除标准并进行倾向评分匹配后，有226例患者，其中113例被纳入手术组，113例被纳入非手术组。使用卡方检验和独立样本t检验分析人口统计学特征、基础疾病、肋骨骨折数量、住院时间、重症监护病房（ICU）住院时间、机械通气时间、入院时骨折合并症、疼痛指数和骨折愈合情况。
手术组的疼痛评分和骨折愈合时间显著改善（P<0.05），而手术组的止痛药使用时间显著缩短（P=0.009）。然而，两组之间在死亡率、骨不连发生率、ICU住院时间或机械通气时间方面没有显著差异。
对于临床研究中的患者，内固定手术可以缩短骨折愈合时间并减少止痛药的使用。手术治疗被确定为安全的，因为它没有增加老年患者的死亡率。对于无手术禁忌证的老年单纯肋骨骨折患者，建议进行内固定手术。
