Abstract

 

OBJECTIVES

First experiences with rib fixation using nitinol, in terms of reliability and morbidity, influence on pain control and quality of life (QOL), in a large series of selected patients after blunt chest trauma.

METHODS

Data of all patients who had undergone rib fixation by the use of nitinol were retrospectively analysed in terms of indications, morbidity and in-hospital mortality. Pain status and health-related QOL were assessed preoperatively, when possible, at discharge and at 1, 3, 6 and 12 months post-surgery using visual analogous scale and short form 12 questionnaires.

RESULTS

From September 2017 to April 2019, 70 patients underwent rib fixation using the nitinol device, of which 47 (67%) had dislocated, painful fractures, 6 (8.5%) had flail chest injuries, 6 (8.5%) were emergencies with haemodynamical instability and 11 (16%) had pseudoarthrosis. Morbidity was 21% without wound infection; in-hospital mortality was 3%. Fracture of the material occurred in 6% of the patients during the first year, but removal of the material was not required. Analysis of the pain score showed a statistically significant decrease in pain for both the whole collective and the group with a series of dislocated and painful fractured ribs (P < 0.001, Tukey contrast on the linear mixed-effects models). Assessment of health-related QOL revealed a significant improvement in the physical score for the mid- and long-term analysis.

CONCLUSIONS

Our results suggest that rib fixation using the nitinol device is reliable, associated with an acceptable morbidity, while significantly decreasing pain and improving health-related QOL.

中文翻译：

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在选定的钝性外伤患者中使用镍钛合金无螺钉系统进行胸壁稳定和肋骨固定：单中心经验的长期结果

摘要

 

目标

使用镍钛诺进行肋骨固定的首次体验，在可靠性和发病率、对疼痛控制和生活质量 (QOL) 的影响方面，在大量胸部钝性创伤后选定的患者中进行。

方法

回顾性分析了所有使用镍钛合金进行肋骨固定的患者的适应症、发病率和住院死亡率。在可能的情况下，在出院时以及术后 1、3、6 和 12 个月时，使用视觉模拟量表和 12 份简短问卷对疼痛状态和健康相关的生活质量进行评估。

结果

2017 年 9 月至 2019 年 4 月，70 例患者使用镍钛合金装置进行肋骨固定，其中 47 例（67%）为脱位、疼痛性骨折，6 例（8.5%）为连枷胸伤，6 例（8.5%）为急诊血流动力学不稳定11 人 (16%) 患有假关节病。无伤口感染的发病率为 21%；住院死亡率为3%。第一年有 6% 的患者发生材料骨折，但不需要移除材料。疼痛评分分析显示，整个集体和一系列脱臼和疼痛的肋骨骨折组的疼痛都有统计学意义的下降（P < 0.001，线性混合效应模型上的 Tukey 对比度）。健康相关 QOL 的评估显示，中长期分析的身体评分显着提高。

结论

我们的研究结果表明，使用镍钛诺装置固定肋骨是可靠的，与可接受的发病率相关，同时显着减少疼痛并改善与健康相关的 QOL。