Clinical treatment of elderly rib fracture complicated with multiple injuries
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 diag-nosed 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.Observa-tion and analysis:①The treatment of multiple rib fractures or flail chest in the elderly.②Treatment characteris-tics of multiple rib fractures combined with craniocerebral injury in the elderly.③Statistical analysis of the in-crease of mechanical ventilation time and oxygenation index in elderly patients with multiple rib fractures and se-vere lung contusion and mild to moderate lung contusion undergoing surgery or conservative treatment.④Treat-ment of elderly patients with multiple rib fractures combined with chronic diseases.Results:①Group 1,group 2 and group 3 patients with basic cardiopulmonary diseases such as coronary heart disease,chronic heart failure,re-fractory 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 com-pared with comprehensive conservative treatment,and there was no statistical significance in the increase of me-chanical 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 ventila-tion time and oxygenation index(P＜0.05).Conclusion:The elderly rib fracture complicated with multiple inju-ries 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 contu-sion,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.
elderly rib fracturemultiple injuriesflailchest lung contusionsurgical stabilization of rib fracture
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