迟做总比不做好——单中心回顾延迟肋骨固定治疗症状性肋骨骨折和不愈合。
Better late than never-a single-center review of delayed rib fixation for symptomatic rib fractures and nonunions.
机构信息
From the Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
出版信息
J Trauma Acute Care Surg. 2023 Dec 1;95(6):880-884. doi: 10.1097/TA.0000000000004136. Epub 2023 Sep 12.
BACKGROUND
Surgical stabilization of rib fractures (SSRFs) has become an emerging therapy for treatment of patients with rib fractures. More commonly, it is used in the acute setting; however, delayed SSRF can be utilized for symptomatic rib fracture nonunions. Here, we describe our institution's experience with delayed SSRF, hypothesizing it is safe and resolves patient symptoms.
METHODS
This is a retrospective review of patients presenting to our Level I trauma center to undergo delayed SSRF for symptomatic nonunions from January 2017 to September 2022. Delayed SSRF was defined as SSRF over 2 weeks in the outpatient setting. Basic demographics were obtained. Outcomes of interest included mean pain score (preoperatively and postoperatively), intensive care unit (ICU) and hospital length of stay (LOS), and resolution of preoperative symptoms, specifically chest wall instability, with return to activities of daily living (ADLs).
RESULTS
Forty-four patients met inclusion criteria with a total of 156 symptomatic nonunion rib fractures that received delayed SSRF. The average age was 59.2 ± 11.9 years and median number of days from injury to SSRF was 172.5 (interquartile range, 27.5-200). The average number rib fractures plated per patient 3.5 ± 1.8. Only three patients required ICU admission postoperatively for no longer than 2 days. Median hospital LOS was 2 days (interquartile range 1-3 days). Average preoperative and postoperative pain score was 6.8 ± 1.9 and 2.02 ± 1.5, respectively ( p < 0.001). Chest wall instability and preoperative symptoms resolved in 93.2% of patients postoperatively ( p < 0.001). Two patients (4.5%) had postoperative complications that resolved after additional surgical intervention. Rib fracture healing was demonstrated on radiographic imaging during postoperative follow-up.
CONCLUSION
Delayed SSRF is safe and demonstrates significant resolution of preoperative symptoms by decreasing pain, improving chest wall stability, and allowing patients to return to activities of daily living.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
背景
肋骨骨折的外科固定（Surgical Stabilization of Rib Fractures，SSRF）已成为治疗肋骨骨折患者的新兴疗法。它通常在急性期使用；然而，延迟性 SSRF 可用于治疗症状性肋骨骨折不愈合。在此，我们介绍了我们机构在延迟性 SSRF 方面的经验，假设其是安全的，并能缓解患者的症状。
方法
这是一项回顾性研究，纳入了 2017 年 1 月至 2022 年 9 月期间因症状性不愈合而在我们的一级创伤中心接受延迟性 SSRF 的患者。延迟性 SSRF 定义为门诊治疗超过 2 周的 SSRF。获取了基本人口统计学数据。感兴趣的结果包括术前和术后的平均疼痛评分、重症监护病房（Intensive Care Unit，ICU）和住院时间（Length of Stay，LOS），以及术前症状（特别是胸壁不稳定）的缓解情况，以恢复日常生活活动（Activities of Daily Living，ADLs）。
结果
44 名患者符合纳入标准，共有 156 处症状性非愈合肋骨骨折接受了延迟性 SSRF。平均年龄为 59.2 ± 11.9 岁，从受伤到 SSRF 的中位数天数为 172.5（四分位距，27.5-200）。每位患者平均接受 3.5 ± 1.8 根肋骨固定。只有 3 名患者术后因不超过 2 天而需要入住 ICU。中位住院时间为 2 天（四分位距 1-3 天）。平均术前和术后疼痛评分分别为 6.8 ± 1.9 和 2.02 ± 1.5（p < 0.001）。术后 93.2%（p < 0.001）的患者胸壁不稳定和术前症状得到缓解。2 名患者（4.5%）术后出现并发症，经进一步手术干预后得到解决。术后随访时影像学检查显示肋骨骨折愈合。
结论
延迟性 SSRF 是安全的，并通过减轻疼痛、改善胸壁稳定性和使患者恢复日常生活活动来显著缓解术前症状。
证据水平
治疗/护理管理；IV 级。
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