Klinik Araştırma
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Multipl kot kırıklarında kot stabilizasyonu ve konservatif tedavinin etkinliğinin karşılaştırılması

Yıl 2022, Cilt: 5 Sayı: 3, 397 - 403, 31.12.2022
https://doi.org/10.36516/jocass.1163861

Öz

Giriş: Yelken göğüse neden olmayan multipl kot kırıkları için cerrahi endikasyonlar konusunda küresel bir kılavuz veya fikir birliği yoktur. Çalışmadaki amacımız, yelken göğüs dışı nedenlerle kot stabilizasyonu uygulanan hastalar ile konservatif tedavi uygulanan hastaların sonuçlarını karşılaştırmaktır.
Gereç ve Yöntem: 2010 Ocak ile 2021 Aralık ayı arasında künt travma sonrası kliniğimize başvuran, multipl kot kırığı saptanan 53 hasta çalışmaya dahil edildi. Kot stabilizasyonu yapılan hastalar grup 1, konservatif tedavi uygulanan hastalar ise grup 2 olarak kabul edildi. İki grup yaş, cinsiyet, travma nedeni, fraktür sayısı, eşlik eden pulmoner yaralanmalar, eşlik eden toraks dışı yaralanmalar, tüp torakostomi takip süresi, intravenöz analjezik kullanım süresi, kan transfüzyon miktarı, hemoglobin düzeyinde azalma miktarı, yoğun bakım yatış süresi, hastane yatış süresi, pulmoner komplikasyonlar ve mortalite açısından karşılaştırıldı.
Bulgular: Kot stabilizasyonu uygulanan 17 hastada cerrahi endikasyonlar: 6 hastada parankim yaralanması ve masif hava kaçağı, 5 hastada clotted hemotoraks ve akciğer ekspansiyon kusuru, 3 hastada deplase segmentin 15 mm’den fazla olduğu multipl kot kırığı, 2 hastada intravenöz analjezik tedaviye rağmen şiddetli ağrı ve 1 hastada göğüs kafesinde volüm kaybına neden olan multipl kot kırığı idi. Kot stabilizasyonu yapılan hastalar ile yapılmayanlar arasında intravenöz analjezik kullanım süresi, yoğun bakım ve hastane yatış süresi açısından anlamlı fark vardı. Ancak tüp torakostomi takip süresi, kan transfüzyon miktarı, hemoglobin düzeyinde düşme miktarı, pulmoner komplikasyon ve mortalite açısından anlamlı fark saptanmadı.
Sonuç: Multipl kot kırıklarının cerrahi stabilizasyonu intravenöz analjezik kullanım süresi, yoğun bakım ve hastane yatış süresini azaltan güvenli ve etkili bir prosedürdür.

Kaynakça

  • 1. Lin FC, Li RY, Tung YW, Jeng KC, Tsai SC. Morbidity, mortality, associated injuries, and management of traumatic rib fractures. J Chin Med Assoc 2016; 79: 329-334.
  • 2. Sirmali M, Türüt H, Topçu S, ve ark. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J CardiothoracSurg 2003; 24: 133-138.
  • 3. Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg 2013; 205: 511-5; discusssion 515-6.
  • 4. Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg 2014; 76: 462-468.
  • 5. Cameron P, Dziukas L, Hadj A, Clark P, Hooper S. Rib fractures in major trauma. Aust N Z J Surg. 1996;66(8):530–4. 6. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975–9.
  • 7. Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 2002;45(1):43–6.
  • 8. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–85.
  • 9. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–6 discussion 6-7. 10. Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32 discussion 32.
  • 11. Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013;216(5):924–32.
  • 12. Qiu M, Shi Z, Xiao J, Zhang X, Ling S, Ling H. Potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures. Indian J Surg. 2016;78(6):458–63.
  • 13. Majercik S, Vijayakumar S, Olsen G, et al. Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema. Am J Surg. 2015;210(6):1112–6 discussion 6-7.
  • 14. Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury. 2015;46(1):61–5.
  • 15. Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009; 56(3):230–42.
  • 16. Peek J, Smeeing DPJ, Hietbrink F, Houwert RM, Marsman M, de Jong MB. Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2018; 18:21-7.
  • 17. Bottlang M, Long WB, Phelan D, Fielder D, Madey SM. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury 2013; 44: 232-238.
  • 18. Mayberry J. Surgical stabilization of severe rib fractures: Several caveats. J Trauma Acute Care Surg 2015; 79: 515.
  • 19. Pieracci FM, Lin Y, Rodil M, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg 2016; 80: 187-194.
  • 20. Pieracci FM, Rodil M, Stovall RT, et al. Surgical stabilization of severe rib fractures. J Trauma Acute Care Surg 2015; 78: 883-887.
  • 21. Majercik S, Cannon Q, Granger SR, VanBoerum DH, White TW. Long-term patient outcomes after surgical stabilization of rib fractures. Am J Surg 2014; 208: 88-92.
  • 22. de Moya M, Bramos T, Agarwal S, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma 2011; 71: 1750- 1754.
  • 23. Cacchione RN, Richardson JD, Seligson D. Painful nonunion of multiple rib fractures managed by operative stabilization. J Trauma. 2000;48(2):319–21.
  • 24. Girsowicz E, Falcoz PE, Santelmo N, Massard G. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-fail rib fractures? Interact CardioVasc Thorac Surg. 2012;14(3):312–5
  • 25. Uchida K, Nishimura T, Takesada H, et al. Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-scor matched analysis. Eur J Trauma Emerg Surg. 2017 Aug;43(4):541-547.

Comparison of the efficacy of rib stabilization and conservative treatment in multiple rib fractures

Yıl 2022, Cilt: 5 Sayı: 3, 397 - 403, 31.12.2022
https://doi.org/10.36516/jocass.1163861

Öz

Objective: There is no global guideline or consensus on surgical indications for multiple rib fractures that do not cause flail chest. Our aim in the study is to compare the results of patients who underwent rib stabilization for reasons other than flail chest and those who received conservative treatment.
Materials and Methods: 53 patients with multiple rib fractures who applied to our clinic after blunt trauma between January 2010 and December 2021 were included in the study. The patients who underwent rib stabilization were accepted as group 1, and the patients who underwent conservative treatment were considered as group 2. Two groups age, gender, cause of trauma, number of fractures, accompanying pulmonary injuries, accompanying extrathoracic injuries, tube thoracostomy follow-up time, duration of intravenous analgesic use, amount of blood transfusion, amount of decrease in hemoglobin level, length of intensive care unit stay, length of hospital stay, pulmonary complications and mortality were compared.
Results: Indications for surgery in 17 patients who underwent rib stabilization: parenchymal injury and massive air leak in 6 patients, clotted hemothorax and lung expansion defect in 5 patients, multiple rib fractures of the displaced segment greater than 15 mm in 3 patients, severe pain despite intravenous analgesic therapy in 2 patients, and multiple rib fractures causing volume loss in the thorax in 1 patient. There was a significant difference between the patients who had rib stabilization and those who did not, in terms of duration of intravenous analgesic use, intensive care unit and hospital stay. However, no significant difference was found in terms of tube thoracostomy follow-up time, blood transfusion amount, decrease in hemoglobin level, pulmonary complications and mortality.
Conclusion: Surgical stabilization of multiple rib fractures is a safe and effective procedure that reduces the duration of intravenous analgesic use, length of intensive care unit and hospital stay.

Kaynakça

  • 1. Lin FC, Li RY, Tung YW, Jeng KC, Tsai SC. Morbidity, mortality, associated injuries, and management of traumatic rib fractures. J Chin Med Assoc 2016; 79: 329-334.
  • 2. Sirmali M, Türüt H, Topçu S, ve ark. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J CardiothoracSurg 2003; 24: 133-138.
  • 3. Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg 2013; 205: 511-5; discusssion 515-6.
  • 4. Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg 2014; 76: 462-468.
  • 5. Cameron P, Dziukas L, Hadj A, Clark P, Hooper S. Rib fractures in major trauma. Aust N Z J Surg. 1996;66(8):530–4. 6. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975–9.
  • 7. Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 2002;45(1):43–6.
  • 8. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–85.
  • 9. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040–6 discussion 6-7. 10. Tanaka H, Yukioka T, Yamaguti Y, et al. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32 discussion 32.
  • 11. Marasco SF, Davies AR, Cooper J, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013;216(5):924–32.
  • 12. Qiu M, Shi Z, Xiao J, Zhang X, Ling S, Ling H. Potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures. Indian J Surg. 2016;78(6):458–63.
  • 13. Majercik S, Vijayakumar S, Olsen G, et al. Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema. Am J Surg. 2015;210(6):1112–6 discussion 6-7.
  • 14. Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury. 2015;46(1):61–5.
  • 15. Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009; 56(3):230–42.
  • 16. Peek J, Smeeing DPJ, Hietbrink F, Houwert RM, Marsman M, de Jong MB. Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2018; 18:21-7.
  • 17. Bottlang M, Long WB, Phelan D, Fielder D, Madey SM. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury 2013; 44: 232-238.
  • 18. Mayberry J. Surgical stabilization of severe rib fractures: Several caveats. J Trauma Acute Care Surg 2015; 79: 515.
  • 19. Pieracci FM, Lin Y, Rodil M, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg 2016; 80: 187-194.
  • 20. Pieracci FM, Rodil M, Stovall RT, et al. Surgical stabilization of severe rib fractures. J Trauma Acute Care Surg 2015; 78: 883-887.
  • 21. Majercik S, Cannon Q, Granger SR, VanBoerum DH, White TW. Long-term patient outcomes after surgical stabilization of rib fractures. Am J Surg 2014; 208: 88-92.
  • 22. de Moya M, Bramos T, Agarwal S, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma 2011; 71: 1750- 1754.
  • 23. Cacchione RN, Richardson JD, Seligson D. Painful nonunion of multiple rib fractures managed by operative stabilization. J Trauma. 2000;48(2):319–21.
  • 24. Girsowicz E, Falcoz PE, Santelmo N, Massard G. Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-fail rib fractures? Interact CardioVasc Thorac Surg. 2012;14(3):312–5
  • 25. Uchida K, Nishimura T, Takesada H, et al. Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-scor matched analysis. Eur J Trauma Emerg Surg. 2017 Aug;43(4):541-547.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Makaleler
Yazarlar

Hıdır Esme 0000-0002-0184-5377

Yayımlanma Tarihi 31 Aralık 2022
Kabul Tarihi 4 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 5 Sayı: 3

Kaynak Göster

APA Esme, H. (2022). Multipl kot kırıklarında kot stabilizasyonu ve konservatif tedavinin etkinliğinin karşılaştırılması. Journal of Cukurova Anesthesia and Surgical Sciences, 5(3), 397-403. https://doi.org/10.36516/jocass.1163861
https://dergipark.org.tr/tr/download/journal-file/11303