Ahmed Z, Mohyuddin Z
Department of Thoracic and Vascular Surgery, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
J Thorac Cardiovasc Surg. 1995 Dec;110(6):1676-80. doi: 10.1016/S0022-5223(95)70030-7.
A total of 427 patients with major chest trauma were treated in two major hospitals in Abu Dhabi, United Arab Emirates, during a 10-year period. In 64 of 426 patients, flail chest injury was the dominant factor among other injuries that were insignificant. Among 64 cases of flail chest injury, 25 were managed by internal fixation of ribs, whereas the remaining 38 were managed by endotracheal intubation and intermittent positive-pressure ventilation alone. Of the patients treated by internal fixation 80% (21/26) were weaned from the ventilator within an average of 1.3 days, whereas the remaining 20% (5/26) continued to need assisted ventilation for a longer duration; the total average duration of assisted ventilation for the whole group was 3.9 days. In comparison, among 38 patients with flail chest injury treated by endotracheal intubation and ventilation alone, the average duration of assisted ventilation was 15 days. In the group treated by internal fixation 11% (3/26) of the patients ultimately required a tracheotomy, whereas in the patients treated by intubation and ventilation alone tracheostomy was required in 37% (14/38) of the cases. In the group treated by internal fixation, chest infection was documented in 15% (4/26), septicemia in 4% (1/26), and barotrauma in 0%; in the other group these complications occurred in 50% (19/38), 24% (9/38), and 8% (3/38) of the cases, respectively. The mortality rate was 8% (2/26) in the surgically treated patients, whereas it was 29% (11/38) in the other group. All the deaths in both groups were ascribed to adult respiratory distress syndrome. Average stay in the intensive care unit was 9 days for the patients treated by internal fixation, whereas it was 21 days in the group treated by intubation and ventilation alone. The treatment of flail chest injury in our series by internal fixation resulted in speedy recovery, decreased complications, and better ultimate cosmetic and functional results and proved to be cost effective.
在10年期间，阿拉伯联合酋长国阿布扎比的两家主要医院共收治了427例严重胸部创伤患者。在426例患者中，有64例连枷胸损伤是主要损伤因素，其他损伤不严重。在64例连枷胸损伤患者中，25例行肋骨内固定治疗，其余38例仅行气管插管和间歇正压通气治疗。接受内固定治疗的患者中，80%（21/26）平均在1.3天内脱机，其余20%（5/26）仍需较长时间的辅助通气；整个组的辅助通气总平均时长为3.9天。相比之下，在38例仅接受气管插管和通气治疗的连枷胸损伤患者中，辅助通气的平均时长为15天。接受内固定治疗的组中，11%（3/26）的患者最终需要气管切开，而仅接受插管和通气治疗的患者中，37%（14/38）的病例需要气管切开。接受内固定治疗的组中，有15%（4/26）记录有胸部感染，4%（1/26）有败血症，0%有气压伤；在另一组中，这些并发症分别发生在50%（19/38）、24%（9/38）和8%（3/38）的病例中。手术治疗患者的死亡率为8%（2/26）,而另一组为29%（11/38）。两组所有死亡均归因于成人呼吸窘迫综合征。接受内固定治疗的患者在重症监护病房的平均住院时间为9天，而仅接受插管和通气治疗的组为21天。我们系列中连枷胸损伤采用内固定治疗可实现快速康复、减少并发症，并获得更好的最终美容和功能效果，且证明具有成本效益。
