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2026年8月22日星期六
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成人创伤性连枷胸合并或不合并严重创伤性脑损伤的肋骨骨折手术固定：一项全国性分析

Surgical stabilization of rib fractures in adult trauma patients with flail chest with or without severe traumatic brain injury: A national analysis.

期刊
Injury - International Journal of the Care of the Injured
PMID
42628226
原文
PubMed ↗
发布日期

作者

  • Hazem Nasef — NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA.
  • Brian Chin — University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA.
  • Nikita Nunes — NOVA Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA.
  • Alaina Werling — NOVA Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA.
  • Quratulain Amin — NOVA Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA.
  • D-Dre Wright — University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA.
  • Chadwick Smith — Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA.
  • Tracy Zito — Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA.
  • Adel Elkbuli — Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA. Electronic address: Adel.elkbuli@orlandohealth.com.

作者单位

  • NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA.
  • University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA.
  • NOVA Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA.
  • Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA.
  • Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA. Electronic address: Adel.elkbuli@orlandohealth.com.

摘要

中文

我们旨在比较成年非TBI患者中孤立性连枷胸和重度TBI患者伴连枷胸接受肋骨骨折手术固定（SSRF）与非手术治疗（NOM）的临床结局。使用美国外科医师学会创伤质量改进计划参与者使用文件（ACS-TQIP PUF）数据集（2017-2021年）进行了一项回顾性队列分析。纳入成年非TBI创伤患者中的孤立性连枷胸和重度TBI伴连枷胸患者。结局包括院内死亡率、重症监护病房住院时间（ICU-LOS）、无呼吸机天数（VFDs）、院内并发症和出院去向。在非TBI患者中，SSRF与NOM患者的院内死亡率无显著差异（OR 0.565，95% CI 0.261-1.222，p=0.147）。在重度TBI患者中，SSRF与显著更低的院内死亡率相关（OR 0.275，95% CI 0.088-0.859，p=0.026）。在非TBI和TBI患者中，与NOM相比，SSRF均与显著更长的ICU-LOS（β=2.434，95% CI 1.796-3.098，p<0.001；β=5.009，95% CI 2.866-7.151，p<0.001）、更高的呼吸机相关性肺炎（VAP）风险（OR 4.051，95% CI 1.573-10.435，p=0.004；OR 4.066，95% CI 1.501-11.019，p=0.006）、气管切开（OR 2.061，95% CI 1.143-3.716，p=0.016；OR 3.797，95% CI 1.861-7.744，p<0.001）以及转至住院康复机构（OR 1.452，95% CI 1.089-1.935，p=0.011；OR 2.140，95% CI 1.159-3.949，p=0.015）相关。在成年非TBI孤立性连枷胸创伤患者中，SSRF与NOM相比死亡率相当。在重度TBI伴连枷胸患者中，SSRF与显著降低的院内死亡率相关。

English

We aim to compare clinical outcomes of surgical stabilization of rib fractures (SSRF) versus non-operative management (NOM) in adult non-TBI patients with isolated flail chest and severe TBI patients with flail chest. A retrospective cohort analysis was performed utilizing the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset from 2017 to 2021. Adult non-TBI trauma patients with isolated flail chests and severe TBI patients with flail chests were included. Outcomes included in-hospital mortality, intensive care unit length of stay (ICU-LOS), ventilator-free days (VFDs), in-hospital complications, and discharge disposition. Among non-TBI patients, there was no significant difference in in-hospital mortality between SSRF and NOM patients (OR 0.565, 95% CI 0.261-1.222, p = 0.147). Among severe TBI patients, SSRF was associated with significantly lower odds of in-hospital mortality (OR 0.275, 95% CI 0.088-0.859, p = 0.026). In both non-TBI and TBI patients, SSRF was associated with significantly longer ICU-LOS (Β=2.434, 95% CI 1.796-3.098, p < 0.001; Β=5.009, 95% CI 2.866-7.151, p < 0.001), increased odds of ventilator-associated pneumonia (VAP) (OR 4.051, 95% CI 1.573-10.435, p = 0.004; OR 4.066, 95% CI 1.501-11.019, p = 0.006), tracheostomy (OR 2.061, 95% CI 1.143-3.716, p = 0.016;OR 3.797, 95% CI 1.861-7.744, p < 0.001), and discharge to inpatient rehab (OR 1.452, 95% CI 1.089-1.935, p = 0.011; OR 2.140, 95% CI 1.159-3.949, p = 0.015) compared to NOM. In adult non-TBI trauma patients with isolated flail chest, SSRF is associated with comparable mortality when compared to NOM. Among severe TBI patients with flail chest, SSRF is associated with significantly reduced odds of in-hospital mortality.

分类与指标

研究类型
临床研究
病种
气胸·外伤·胸壁
JCR 分区
Q2
影响因子
2.4
新锐分区
3区