多发肋骨骨折无连枷段成人的放射学肋骨骨折不愈合与骨折分类的相关性：一项多中心前瞻性队列研究。
Radiographic rib fracture nonunion and association with fracture classification in adults with multiple rib fractures without flail segment: A multicenter prospective cohort study.
机构信息
Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands; Department of Surgery, Zuyderland Medisch Centrum, Heerlen, the Netherlands; Department of Surgery, Deventer Ziekenhuis, Deventer, the Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands; Department of Surgery, Ikazia Ziekenhuis, Rotterdam, the Netherlands; Department of Surgery, Rijnstate, Arnhem, the Netherlands; Department of Surgery, Isala, Zwolle, the Netherlands; Department of Surgery, Spaarne Gasthuis, Haarlem, the Netherlands; Department of Surgery, Bravis Ziekenhuis, Roosendaal, the Netherlands; Department of Surgery, HagaZiekenhuis, Den Haag, the Netherlands; Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands; Department of Surgery, Maasstad Ziekenhuis, Rotterdam, the Netherlands; Department of Surgery, Amphia Ziekenhuis, Breda, the Netherlands.
出版信息
Injury. 2024 May;55(5):111335. doi: 10.1016/j.injury.2024.111335. Epub 2024 Jan 19.
BACKGROUND
Rib fracture nonunion is a probable cause of chronic pain following chest trauma, although its prevalence remains unknown. The aims of this study were to determine rib fracture nonunion prevalence following nonoperative management and to determine if presence of nonunion was associated with the number of rib fractures, or the rib fracture classification of anatomical location, type, and displacement.
METHODS
This multicenter prospective cohort study included trauma patients with three or more fractured ribs but without a flail segment, who participated in the nonoperative management group of the FixCon trial between January 2019 and June 2022. The number and classification of rib fractures were assessed on trauma chest CT. Chest CTs conducted six months post-trauma were evaluated for the presence of nonunion. Radiological characteristics of nonunions were compared with normally healed rib fractures using the Mann-Whitney U, χ test, and Fisher's exact test as appropriate. A generalized linear model adjusted for multiple observations per patient when assessing the associations between nonunion and fracture characteristics.
RESULTS
A total of 68 patients were included with 561 post-traumatic fractures in 429 ribs. Chest CT after six months revealed nonunions in 67 (12 %) rib fractures in 29 (43 %) patients with a median of 2 (P-P 1-3) nonunions per patient. Nonunion was most commonly observed in ribs seven to 10 (20-23 %, p < 0.001, adjusted p = 0.006). Nonunion occurred in 14 (5 %) undisplaced, 22 (19 %) offset, and 20 (23 %) displaced rib fractures (p < 0.001). No statistically significant association between rib fracture type and nonunion was found.
CONCLUSIONS
Forty-three percent of patients with multiple rib fractures had radiographic nonunion six months after trauma. Fractures in ribs seven to 10 and dislocated fractures had an increased risk of rib fracture nonunion.
背景
肋骨骨折不愈合是胸部创伤后慢性疼痛的一个可能原因，尽管其患病率尚不清楚。本研究旨在确定非手术治疗后肋骨骨折不愈合的患病率，并确定不愈合是否与肋骨骨折数量、骨折解剖位置、类型和移位的分类有关。
方法
本多中心前瞻性队列研究纳入了有 3 处或以上肋骨骨折但无连枷段的创伤患者，这些患者参加了 2019 年 1 月至 2022 年 6 月间的 FixCon 试验非手术治疗组。通过创伤性胸部 CT 评估肋骨骨折的数量和分类。在创伤后 6 个月时进行胸部 CT 检查，以评估是否存在不愈合。使用 Mann-Whitney U、χ检验和 Fisher 确切检验比较不愈合和正常愈合肋骨骨折的放射学特征。当评估不愈合与骨折特征之间的关联时，使用广义线性模型对每个患者的多个观察值进行调整。
结果
共纳入 68 例患者，429 根肋骨共有 561 处创伤后骨折。6 个月时的胸部 CT 显示 29 例（43%）患者的 67 处（12%）肋骨骨折有不愈合，中位数为 2 处（P-P 1-3）不愈合/患者。不愈合最常见于第 7-10 肋骨（20-23%，p<0.001，调整后 p=0.006）。14 处（5%）无移位、22 处（19%）偏移和 20 处（23%）移位的肋骨骨折发生不愈合（p<0.001）。肋骨骨折类型与不愈合之间无统计学显著关联。
结论
创伤后 6 个月时，43%的多发性肋骨骨折患者有影像学不愈合。第 7-10 肋骨骨折和移位骨折的肋骨骨折不愈合风险增加。
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