El Kayali Moses K D, Böning Georg, Mewes Moritz Günther, Braun Karl F, Steinecke Karin, Neumann Konrad, Stöckle Ulrich, Jaecker Vera, Niemann Marcel
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
J Clin Med. 2025 May 22;14(11):3644. doi: 10.3390/jcm14113644.
Flail chest (FC) injuries are multiple adjacent segmental rib fractures, commonly associated with a high complication and mortality risk. Recent evidence suggests that the early surgical stabilization of FC injuries is beneficial for restoring breathing mechanics. However, little is known about the effects on lung volumes when invasive ventilation is performed after surgery. This retrospective study included multiple trauma (MT) patients operatively treated for an FC injury between 2011 and 2024. The indication for surgery was based on a computed tomography (CT) proof of an FC, objectifiable paradoxical breathing, and prolonged weaning. All patients treated used a single osteosynthesis system. Lung volumes were manually measured in preoperative and postoperative CT scans of the thorax in the thinnest CT reconstructions available. The primary outcomes of interest were the changes in the lung volumes following surgical stabilization of the FC. During this study, 21 patients (90.48% male) were operatively treated for their FC injury. All patients had been affected by high-energy trauma. The corresponding median Injury Severity Score (ISS) was 26 (IQR 17.5, 33). Patients suffered 7 (IQR 6, 10) and 6 (IQR 2, 9) fractured ribs of the left and right hemithorax, respectively. Three (IQR 0, 3) and two (IQR 0, 3) ribs of the left and right hemithorax, respectively, were stabilized at 7 (IQR 2, 18) days post admission. There were no significant changes in the lung volumes comparing preoperative and postoperative CT scans. As this study did not detect CT volume changes comparing preoperative and postoperative scans, CT scans following surgery may not qualify for an objective measurement of the surgical effectiveness regarding lung volume restoration in the short-term follow-up. Long-term changes in CT-measured lung volume changes need to be evaluated to prove an objective surrogate parameter for surgical effectiveness regarding the restoration of the thorax integrity.
连枷胸（FC）损伤是多根相邻节段性肋骨骨折，通常伴有较高的并发症和死亡风险。最近的证据表明，FC损伤的早期手术固定有利于恢复呼吸力学。然而，对于术后进行有创通气时对肺容积的影响知之甚少。这项回顾性研究纳入了2011年至2024年间接受FC损伤手术治疗的多发伤（MT）患者。手术指征基于FC的计算机断层扫描（CT）证据、可客观化的反常呼吸和长时间脱机困难。所有接受治疗的患者均使用单一接骨系统。在术前和术后胸部CT扫描的最薄层重建图像中手动测量肺容积。主要关注的结果是FC手术固定后肺容积的变化。在这项研究中，21例患者（90.48%为男性）接受了FC损伤的手术治疗。所有患者均受到高能创伤影响。相应的损伤严重程度评分（ISS）中位数为26（四分位间距17.5，33）。患者左、右半胸分别有7根（四分位间距6，10）和6根（四分位间距2，9）肋骨骨折。左、右半胸分别有3根（四分位间距0，3）和2根（四分位间距0，3）肋骨在入院后7天（四分位间距2，18）得到固定。术前和术后CT扫描比较，肺容积无显著变化。由于本研究未检测到术前和术后扫描的CT容积变化，术后CT扫描可能无法作为短期随访中肺容积恢复手术效果的客观测量指标。需要评估CT测量的肺容积变化的长期变化，以证明胸廓完整性恢复手术效果的客观替代参数。
