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创伤性肋骨骨折住院病人的处理

Author
Eileen M Bulger, MD, FACS
Section Editors
Joseph S Friedberg, MD
Heidi L Frankel, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
杨鲲鹏, 主任医师，教授

引言

多发性肋骨骨折是显著的暴力冲击胸壁的结果，最常由钝挫伤(如，机动车碰撞、坠落及人为袭击)所致，但穿入伤(如，枪击)也可造成多根肋骨骨折。肋骨骨折占所有创伤患者的10%，占显著胸部创伤患者的约30%。胸内损伤的存在与骨折肋骨的数量直接相关[1,2]。多根多处肋骨骨折可引起严重损害呼吸功能的连枷胸(或开放性胸部创伤)[3]。治疗多发性肋骨骨折的主要目标在于控制疼痛、支持呼吸功能，以及通过机械通气或外科骨折固定术来稳定胸壁。

本专题将讨论多发性创伤性肋骨骨折住院患者的治疗。胸部钝挫伤的一般诊疗方法及单处或非创伤性肋骨骨折的一般注意事项将在别处讨论。 (参见“成人钝性胸部损伤的初步评估和处理”和“肋骨骨折的初期评估与处理”)

创伤评估

钝挫伤或穿入伤患者的初始复苏、诊断性评估及治疗方法均基于美国外科医师协会创伤委员会制定的高级创伤生命支持(Advanced Trauma Life Support, ATLS)方案。 (参见“成人创伤的早期处理”)

腹部或胸部钝挫伤或穿入伤患者的初始复苏和评估将在别处详细讨论。 (参见“成人腹部钝挫伤的初始评估和处理”和“成人腹部枪伤的初步评估和处理”和“成人钝性胸部损伤的初步评估和处理”和“成人胸部穿透伤的初始评估和处理”)

由于肋骨骨折数量增加与患者的并发症发病率及死亡率升高明确相关，所以当患者存在3根或更多根肋骨骨折时，即提示需住院治疗或转入当地的创伤机构[1,4-8]。存在6根或更多根肋骨骨折与患者死亡率显著升高(通常是由相关的损伤所致)有关。老年患者(年龄>65岁)出现肋骨骨折相关并发症的风险有所增加，因此所有老年骨折患者都应考虑住院治疗。 (参见下文‘合并伤’和‘并发症发病率和死亡率’)

                                           

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-30.
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