Thompson B M, Finger W, Tonsfeldt D, Aprahamian C, Troiano P, Hendley G, Mateer J, Stueven H
Ann Emerg Med. 1986 Mar;15(3):261-5. doi: 10.1016/s0196-0644(86)80561-3.
In trauma to the chest, the clinical impression and the physical findings of rib fractures are nonspecific. Fractures often are not seen on initial films. The principal diagnostic goal should be the detection of significant complications (pneumothorax, hemothorax, major vascular injury, or pulmonary contusion) requiring admission. The therapeutic effort should be to provide pain relief and prevent the delayed development of atelectasis or pneumonia in patients with painful chest wall injuries, whether or not a fracture is detected initially. An upright posteroanterior chest radiograph has the greatest yield in detecting fractures and complications resulting from them. Tomograms and expiratory, oblique, and "coned-down" views should not be done routinely. The use of these more specific examinations may be indicated, however, in such cases as trauma to ribs 1 to 3 or 9 to 12. Their selective use in isolated cases (trauma to ribs 1 to 3 or 9 to 12) and suspected child abuse may indicate the need for these more specific examinations. Because detection of pulmonary complications of chest trauma is most important, a delayed or repeat upright posteroanterior chest radiograph may be the most cost-effective second radiograph. Significant medical care cost savings may be appreciated by limiting the use of specific rib views to instances in which it might influence the patient's therapy.
在胸部创伤中，肋骨骨折的临床印象和体格检查结果不具有特异性。最初的X线片上常看不到骨折。主要的诊断目标应是发现需要住院治疗的严重并发症（气胸、血胸、大血管损伤或肺挫伤）。治疗应致力于缓解疼痛，并预防胸壁疼痛损伤患者发生肺不张或肺炎的延迟发生，无论最初是否检测到骨折。立位后前位胸部X线片在检测骨折及其所致并发症方面的阳性率最高。断层扫描以及呼气位、斜位和“点片”检查不应作为常规检查。然而，在第1至3肋或第9至12肋骨折等情况下，可能需要进行这些更具特异性的检查。在个别病例（第1至3肋或第9至12肋骨折）和疑似虐待儿童的情况下选择性使用这些检查，可能表明需要进行这些更具特异性的检查。由于检测胸部创伤的肺部并发症最为重要，延迟或重复立位后前位胸部X线片可能是最具成本效益的第二次影像学检查。通过将特异性肋骨视图的使用限制在可能影响患者治疗的情况下，可以显著节省医疗费用。
