肋骨骨折部位对早期胸内合并伤及并发症的影响  

Influence of rib fracture sites on early intrathoracic concomitant injuries and complications

作　　者：余长永 刘武新 朱康宇 王强 Yu Changyong;Liu Wuxin;Zhu Kangyu;Wang Qiang(Department of Thoracic Surgery,Jiangsu Shengze Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu 215228,China;Department of General Surgery,Jiangsu Shengze Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu 215228,China)

机构地区：[1]南京医科大学附属江苏盛泽医院胸外科,江苏苏州215228 [2]南京医科大学附属江苏盛泽医院普外科,江苏苏州215228

出　　处：《创伤外科杂志》2021年第2期97-102,共6页Journal of Traumatic Surgery

摘　　要：目的研究肋骨骨折部位与早期胸内合并伤及并发症的结局关系,确定引起上述合并伤及并发症的高风险部位,并评判其对早期胸内并发症的预测价值。方法回顾性研究2019年1月—2019年11月南京医科大学附属江苏盛泽医院收治的肋骨骨折患者272例,男性193例(71%),女性79例(29%);年龄19~97岁,平均57.1岁。肋骨骨折数(4.4±2.7)根,胸壁损伤简明损伤定级评分(AIS)(3.4±0.9)分,ISS评分(17.0±9.3)分,新损伤严重度评分(NISS)(26.6±11.6)分,住院天数(11.7±7.0)d。肋骨骨折部位:上胸部近胸骨段66例、上胸部前外侧段31例、上胸部后外侧段7例、上胸部近脊柱段15例、中胸部近胸骨段110例、中胸部前外侧段73例、中胸部后外侧段21例、中胸部近脊柱段45例、下胸部近胸骨段28例、下胸部前外侧段31例、下胸部后外侧段25例、下胸部近脊柱段60例。早期胸内并发症:气胸62例、血胸201例、血气胸58例、肺挫伤191例、纵隔气肿18例、肺不张62例、皮下气肿29例以及心肌挫伤64例。统计分析肋骨骨折部位与早期胸内并发症的相关性。结果多因素Logistic回归分析显示,上胸部前外侧段是气胸、血气胸、纵隔气肿、皮下气肿的独立危险因素(P<0.05),相应ROC曲线下面积分别为0.65(95%CI:0.56~0.73)、0.65(95%CI:0.56~0.74)、0.80(95%CI:0.66~0.93)、0.67(95%CI:0.55~0.79);而中胸部近脊柱段是血胸的独立危险因素(P<0.05),ROC曲线下面积为0.59(95%CI:0.52~0.66)。结论上胸部前外侧段肋骨骨折与气胸、血气胸、纵隔气肿、皮下气肿,以及中胸部近脊柱段肋骨骨折与血胸的发生存在显著相关性,分别是胸内合并伤及并发症发生的独立危险因素,具有预测早期胸内并发症发生的价值。Objective By investigating the relationship between rib fracture sites and the occurrences of early intrathoracic concomitant injuries and complications,the sites at high risk for causing the above intrathoracic injuries were identified,and their predictive value for early intrathoracic concomitant injuries and complications was evaluated.Methods The clinical data of 272 patients with rib fractures admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University from Jan.to Nov.2019 were retrospectively studied.There were 193 male patients(71%)and 79 female patients(29%),with an average age of 57.1 years(range,19-97 years).The number of rib fractures was 4.4±2.7,the AIS of chest wall trauma was(3.4±0.9)points,the injury severity score(ISS)was(17.0±9.3)points,the new injury severity score(NISS)was(26.6±11.6)points,and the length of hospital stay was(11.7±7.0)days.Rib fracture sites were divided into the upper chest proximal sternal segment(66 cases),upper chest anterolateral segment(31 cases),upper chest posterolateral segment(7 cases),upper chest proximal spinal segment(15 cases),middle chest proximal sternal segment(110 cases),middle chest anterolateral segment(73 cases),middle chest posterolateral segment(21 cases),middle chest proximal spinal segment(45 cases),lower chest proximal sternal segment(28 cases),lower chest anterolateral segment(31 cases),lower chest posterolateral segment(25 cases),and lower chest proximal spinal segment(60 cases).Early intrathoracic injuries and complications included pneumothorax in 62 cases,hemothorax in 201 cases,hemothorax in 58 cases,pulmonary contusion in 191 cases,mediastinal emphysema in 18 cases,pulmonary atelectasis in 62 cases,subcutaneous emphysema in 29 cases and myocardial contusion in 64 cases.The correlation between rib fracture sites and early intrathoracic concomitant injuries and complications was statistically analyzed.Results Multivariate Logistic regression analysis showed that the upper chest anterolateral segment was an independent risk fa

关 键 词：肋骨骨折 骨折部位 胸内并发症 Logistic回归分析 

分 类 号：R683.1[医药卫生—骨科学]