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肋骨骨折保守治疗中愈合不良及长期疼痛的危险因素分析

Analysis of risk factors for poor healing and long-duration pain in conservative treatment of rib fractures.

作者信息

Yao Yongzheng, Li Shida, Bi Chao, Duan Jiayu, Jiao Lianjie, Zheng Jie, Wang Lihui, Qian Gaoyang

机构信息

Department of Thoracic Surgery, Peking University First Hospital - MiYun Hospital, Beijing, China.

Department of Ultrasound, Peking University First Hospital - MiYun Hospital, Beijing, China.

出版信息

Medicine (Baltimore). 2024 Dec 20;103(51):e40358. doi: 10.1097/MD.0000000000040358.

Abstract

Rib fractures are a common injury following blunt chest trauma, accounting for approximately 10% of all traumatic injuries and up to 50% of blunt chest trauma cases. These fractures are associated with a high risk of complications, such as pneumothorax, hemothorax, and pulmonary infections, and can significantly impact respiratory function. This study analyzes the risk factors for poor healing and long-duration pain in the conservative treatment of rib fractures, providing a reference for clinicians in choosing conservative treatment and formulating treatment plans. A retrospective analysis was conducted on 342 patients who underwent conservative treatment for rib fractures from January 2023 to May 2024. Baseline data, clinical data, and follow-up data were collected. Comparisons were made between the poor healing group and the good healing group, as well as between the long-duration pain group and the short-duration pain group in the conservative treatment of rib fractures. Univariate and multivariate logistic regression analyses were performed to identify risk factors for poor healing and long-duration pain. In patients undergoing conservative treatment for rib fractures, the average duration of pain was 12.18 ± 10.78 days, with an incidence of pulmonary complications of 59.06% (202/342) and poor healing rate of 6.43% (22/342). Significant differences were observed between the good and poor healing groups in terms of age (P = .018), presence of coronary heart disease (CHD, P = .023), chronic obstructive pulmonary disease (COPD, P < .001), blood calcium (P = .007), and alkaline phosphatase (P < .001). Similarly, significant differences were found between the long-duration and short-duration pain groups in age (P = .039), presence of diabetes (P < .001), CHD (P < .001), COPD (P < .001), and alkaline phosphatase (P < .001). Multivariate analysis identified COPD (P = .015), blood calcium (P = .013), and alkaline phosphatase (P = .006) as independent risk factors for poor healing, while diabetes (P = .001), CHD (P = .014), and alkaline phosphatase (P < .001) were independent risk factors for prolonged pain duration. COPD, blood calcium, and alkaline phosphatase are independent risk factors for poor healing in conservative treatment of rib fractures. Diabetes, CHD, and alkaline phosphatase are independent risk factors for long-duration pain in conservative treatment of rib fractures.

摘要

肋骨骨折是钝性胸部创伤后的常见损伤,约占所有创伤性损伤的10%,在钝性胸部创伤病例中占比高达50%。这些骨折与气胸、血胸和肺部感染等并发症的高风险相关,并可显著影响呼吸功能。本研究分析肋骨骨折保守治疗中愈合不良和长期疼痛的危险因素,为临床医生选择保守治疗和制定治疗方案提供参考。对2023年1月至2024年5月接受肋骨骨折保守治疗的342例患者进行回顾性分析。收集基线数据、临床数据和随访数据。对肋骨骨折保守治疗中愈合不良组与愈合良好组、长期疼痛组与短期疼痛组进行比较。进行单因素和多因素逻辑回归分析以确定愈合不良和长期疼痛的危险因素。在接受肋骨骨折保守治疗的患者中,平均疼痛持续时间为12.18±10.78天,肺部并发症发生率为59.06%(202/342),愈合不良率为6.43%(22/342)。愈合良好组与愈合不良组在年龄(P = .018)、冠心病(CHD,P = .023)、慢性阻塞性肺疾病(COPD,P < .001)、血钙(P = .007)和碱性磷酸酶(P < .001)方面存在显著差异。同样,长期疼痛组与短期疼痛组在年龄(P = .039)、糖尿病(P < .001)、CHD(P < .001)、COPD(P < .001)和碱性磷酸酶(P < .001)方面存在显著差异。多因素分析确定COPD(P = .015)、血钙(P = .013)和碱性磷酸酶(P = .006)为愈合不良的独立危险因素,而糖尿病(P = .001)、CHD(P = .014)和碱性磷酸酶(P < .001)为疼痛持续时间延长的独立危险因素。COPD、血钙和碱性磷酸酶是肋骨骨折保守治疗中愈合不良的独立危险因素。糖尿病、CHD和碱性磷酸酶是肋骨骨折保守治疗中长期疼痛的独立危险因素。

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