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摘要: 目的 研究老年肋骨骨折合并多发伤的救治特点。方法 将204例老年多发肋骨骨折(≥3根)合并多发伤患者分为3组。一组：以钝性胸伤多发肋骨骨折为主诊，合并其他部位伤，AIS≤2分，共50例；二组：以钝性胸伤多发肋骨骨折为主诊，合并其他部位伤，AIS≥3分，共63例；三组：以钝性胸伤多发肋骨骨折合并颅脑伤为主诊，有(无)其他损伤，共91例。观察分析：①老年多发肋骨骨折或连枷胸的救治情况；②老年多发肋骨骨折合并颅脑损伤的救治特点；③老年多发肋骨骨折并重症肺挫伤、轻中度肺挫伤实施手术和保守治疗的机械通气时间、氧合指数的增长量的统计学分析；④老年多发肋骨骨折合并老年慢性疾病患者的救治。结果 ① 一组、二组、三组患者基础心肺疾病如：冠心病、慢性心衰、顽固性心律失常、风湿性心脏病、扩张型心肌病、支气管扩张、慢性肺部感染、老年慢性肺气肿、哮喘、尘肺、胸廓畸形，均未行手术，采取保守治疗；②采取多发肋骨手术的患者中，连枷胸13例(52%)，多肋骨折12例(48%)；③开颅手术17例，均未行肋骨骨折手术；保守治疗67例，其中重症颅脑损伤患者13例(19.40%)；轻中度颅脑损伤54例，其中7例行肋骨骨折复位内固定术；④对于老年肋骨骨折并重症肺挫伤的多发伤患者，行肋骨骨折固定手术，对照综合性保守治疗，在机械通气时间、氧合指数的增长量，组间差异无统计学意义(P>0.05)；而对于多发肋骨骨折并轻中度肺挫伤的多发伤的患者，行肋骨骨折复位固定术，对照综合性保守治疗，在机械通气时间、氧合指数的增长量，组间差异有统计学意义(P＜0.05)。结论 老年肋骨骨折合并多发伤应实施个体化救治，对于有严重老年疾病、重症颅脑损伤、合并重症肺挫伤的老年肋骨骨折以保守治疗为主；无肺挫伤、轻中度的肺挫伤及合并轻中度的颅脑损伤的老年肋骨骨折，如果多肋骨折连枷胸严重影响了呼吸或循环，宜尽早行手术治疗为主。
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关键词:
- 老年肋骨骨折 /
- 多发伤 /
- 连枷胸 /
- 肺挫伤 /
- 肋骨骨折切开复位内固定手术
Abstract: Objective To study the treatment characteristics of elderly rib fracture complicated with multiple injuries.Methods Two hundred and four elderly patients with multiple rib fractures(≥3) combined with multiple injuries were divided into three groups. Group 1: A total of 50 cases were mainly diagnosed with blunt chest injury and multiple rib fracture combined with other parts injury AIS≤2 points. Group 2: A total of 63 cases were diagnosed with blunt chest injury and multiple rib fracture combined with AIS≥3 points. Group 3: Blunt chest injury with multiple rib fractures combined with craniocerebral injury, 91 cases with or without other injuries. Observation and analysis: ①The treatment of multiple rib fractures or flail chest in the elderly. ②Treatment characteristics of multiple rib fractures combined with craniocerebral injury in the elderly. ③Statistical analysis of the increase of mechanical ventilation time and oxygenation index in elderly patients with multiple rib fractures and severe lung contusion and mild to moderate lung contusion undergoing surgery or conservative treatment. ④Treatment of elderly patients with multiple rib fractures combined with chronic diseases.Results ① Group 1, group 2 and group 3 patients with basic cardiopulmonary diseases such as coronary heart disease, chronic heart failure, refractory arrhythmia, rheumatic heart disease, cardiomyopathy, bronchiectasis, chronic pulmonary infection, old chronic bronchiolar emphysema, asthma, pneumoconiosis and thoracic malformation were treated conservatively. ②Among the patients treated with surgery, 13 cases were flail chest, accounting for 52%, 12 cases were multiple rib fracture, accounting for 48%. ③None of the 17 cases underwent craniotomy for rib fracture. Conservative treatment was given to 67 cases, including 13 severe cases(19.40%). There were 54 cases with mild to moderate craniocerebral injury, and 7 of the 54 cases received internal fixation of rib fracture. ④For elderly patients with multiple injuries of rib fracture and severe pulmonary contusion, rib fracture fixation surgery was performed compared with comprehensive conservative treatment, and there was no statistical significance in the increase of mechanical ventilation time and oxygenation index(P>0.05). For elderly patients with multiple rib fractures and mild to moderate lung contusion, the rib fracture reduction fixation was performed. Compared with comprehensive conservative treatment, there were statistically significant differences in the growth amount of mechanical ventilation time and oxygenation index(P < 0.05).Conclusion The elderly rib fracture complicated with multiple injuries should be treated individually. Conservative treatment should be used for the elderly rib fracture with severe senile diseases, severe craniocerebral injury and severe lung contusion. Elderly rib fractures without lung contusion, mild to moderate lung contusion and mild to moderate cranial injury should be treated with surgery as soon as possible if the respiratory or circulation is seriously affected by multiple rib flail chest. -
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表 1 多发肋骨骨折合并重症肺挫伤患者治疗方式比较
X±S 治疗方式 例数 机械通气时间/h 48 h后氧合指数的增加值 非肋骨手术 31 142.85±12.26 48.80±3.64 肋骨骨折手术 9 121.29±7.42 59.94±5.57 P 0.081 0.139 
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表 2 多发肋骨骨折合并轻中度肺挫伤患者治疗方式比较
X±S 治疗方式 例数 机械通气时间/h 48 h后氧合指数的增加值 非肋骨手术 63 73.47±8.12 63.14±4.18 肋骨骨折手术 16 24.67±3.13 89.94±7.75 P 0.001 0.008
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| 引用本文: |
杜工亮, 马龙洋, 董文刚, 等. 老年肋骨骨折合并多发伤的临床救治分析[J]. 临床急诊杂志, 2024, 25(5): 235-238. doi: 10.13201/j.issn.1009-5918.2024.05.005
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| Citation: |
DU Gongliang, MA Longyang, DONG Wengang, et al. Clinical treatment of elderly rib fracture complicated with multiple injuries[J]. J Clin Emerg, 2024, 25(5): 235-238. doi: 10.13201/j.issn.1009-5918.2024.05.005
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