Kim Hongrye, Yoon Su Young, Han Jonghee, Seok Junepill, Kang Wu Seong
Department of Neurosurgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea.
Medicina (Kaunas). 2025 Jan 6;61(1):81. doi: 10.3390/medicina61010081.
: Two major classification systems exist for rib fracture (RFX) displacement. One system uses a 50% displacement threshold: Grade I (<50%), Grade II (≥50% to <100%), and Grade III (completely dislocated). Another proposes a 10% threshold: Undisplaced (<10%), Offset (≥10% to <100%), and Displaced (completely dislocated). We analyzed risk factors for adverse outcomes for pulmonary complications and mortality according to both classification criteria. : We retrospectively reviewed trauma registry and medical records from January 2019 to December 2023. All radiographic parameters were recorded based on initial computed tomography. Primary outcomes were pneumonia and other pulmonary complications requiring surgery. Least absolute shrinkage and selection operator (LASSO) regression was conducted to select risk factors and minimize overfitting. Multivariable logistic regression (MLR) was performed after LASSO. : Among the 621 patients, 61 (9.8%) had one or more adverse outcomes. In MLR, regardless of both classifications, the age ( < 0.001), ISS ( < 0.001), and number of completely displaced RFX ( = 0.001) were statistically significant. After excluding 280 patients with completely displaced RFX, we conducted a subgroup analysis with the remaining 341 patients. In this analysis, 22 (6.5%) patients experienced one or more adverse outcomes. Regardless of both classifications, the AIS head ( = 0.006), AIS extremities ( = 0.012), and number of segmental RFX ( < 0.001) were statistically significant in MLR. The area under the receiver operating curve for both MLR models was 0.757 in the total patient group and 0.823 in the subgroup that excluded patients with completely displaced RFX. : Completely displaced RFX is the most crucial factor, regardless of the classification criteria. Unless ribs are completely displaced, the degree of displacement may not be crucial, and the number of segmental RFX was a significant risk factor.
肋骨骨折（RFX）移位存在两种主要分类系统。一种系统采用50%的移位阈值：I级（<50%）、II级（≥50%至<100%）和III级（完全脱位）。另一种系统提出10%的阈值：无移位（<10%）、偏移（≥10%至<100%）和移位（完全脱位）。我们根据这两种分类标准分析了肺部并发症和死亡率等不良结局的危险因素。
我们回顾性分析了2019年1月至2023年12月的创伤登记数据和病历。所有影像学参数均基于初次计算机断层扫描记录。主要结局为肺炎和其他需要手术治疗的肺部并发症。采用最小绝对收缩和选择算子（LASSO）回归来选择危险因素并减少过度拟合。在LASSO回归之后进行多变量逻辑回归（MLR）。
在621例患者中，61例（9.8%）出现了一种或多种不良结局。在MLR中，无论采用哪种分类，年龄（<0.001）、损伤严重度评分（ISS，<0.001）和完全移位的肋骨骨折数量（=0.001）均具有统计学意义。在排除280例完全移位的肋骨骨折患者后，我们对其余341例患者进行了亚组分析。在该分析中，22例（6.5%）患者出现了一种或多种不良结局。在MLR中，无论采用哪种分类，简明损伤定级（AIS）头部评分（=0.006）、AIS四肢评分（=0.012）和节段性肋骨骨折数量（<0.001）均具有统计学意义。在总患者组中，两个MLR模型的受试者工作特征曲线下面积为0.757，在排除完全移位肋骨骨折患者的亚组中为0.823。
无论分类标准如何，完全移位的肋骨骨折都是最关键的因素。除非肋骨完全移位，否则移位程度可能并不关键，而节段性肋骨骨折的数量是一个重要的危险因素。
