ﺷﮑﺴﺘﮕﯽ دﻧﺪه در ﺑﯿﻤﺎران ﻣﻮﻟﺘﯽ ﺗﺮوﻣﺎ

Rib Fractures in Multiple Trauma Patients

زﻣﯿﻨﻪ و ﻫﺪف: ﺗﺮوﻣﺎي ﻗﻔﺴﻪ ﺳﯿﻨﻪ ﯾﮑﯽ از ﻋﻠﻞ ﻣﻨﺠﺮ ﺑﻪ ﻣﺮگ و ﻣﯿﺮ در ﺑﯿﻤﺎران ﺗﺮوﻣﺎﯾﯽ ﻣﯽﺑﺎﺷﺪ و ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﺑﻪ ﻋﻠﺖ ﺗﺮوﻣﺎي ﺑﻼﻧﺖ ﺑﻪ ﻗﻔﺴﻪ ﺳﯿﻨﻪ، ﺷﺎﯾﻌﺘﺮﯾﻦ اﺗﯿﻮﻟﻮژي ﻣﯽﺑﺎﺷﺪ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ارﺗﺒﺎط ﺑﯿﻦ ﺷﮑﺴﺘﮕﯽ دﻧﺪه و ﭘﯿﺶ آﮔﻬﯽ ﺑﯿﻤﺎران ﻣﻮﻟﺘﯽ ﺗﺮوﻣﺎ را ﻣﻮرد ارزﯾﺎﺑﯽ ﻗﺮار ﻣﯽدﻫﺪ. ﻣﻮاد و روش ﻫﺎ: ﺻﺪ و ﻫﺸﺘﺎد ﭼﻬﺎر ﺑﯿﻤﺎر ﺗﺮوﻣﺎﯾﯽ ﺑﺎ ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﻧﺎﺷﯽ از ﺗﺮوﻣﺎي ﺑﻼﻧﺖ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. در ﺗﻤﺎﻣﯽ ﺑﯿﻤﺎران ﯾﺎﻓﺘﻪﻫﺎي دﻣﻮﮔﺮاﻓﯿﮏ، وﯾﮋﮔﯽﻫﺎي آﺳﯿﺐ، وﯾﮋﮔﯽﻫﺎي ﺷﮑﺴﺘﮕﯽ دﻧﺪه و ﻧﯿﺰ آﺳﯿﺐﻫﺎي ﻫﻤﺮاه و اﻣﺘﯿﺎز ﺷﺪت آﺳﯿﺐ ISS)( ﺛﺒﺖ ﺷﺪﻧﺪ. ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﺤﻞ )راﺳﺖ، ﭼﭗ و دو ﻃﺮﻓﻪ( و ﺳﻄﺢ ]ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻓﻮﻗﺎﻧﯽ )دﻧﺪه اول و دوم(، ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻣﯿﺎﻧﯽ )دﻧﺪهﻫﺎي ﺳﻮم ﺗﺎ ﻫﺸﺘﻢ( و ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﺗﺤﺘﺎﻧﯽ )دﻧﺪهﻫﺎي ﻧﻬﻢ ﺗﺎ دوزادﻫﻢ([ و ﻧﯿﺰ ﺑﻪ ﺻﻮرت ﻟﺘﺮال و ﭘﻮﺳﺘﺮوﻟﺘﺮال ﻃﺒﻘﻪﺑﻨﺪي ﺷﺪﻧﺪ. ﺗﻤﺎم آﻧﺎﻟﯿﺰﻫﺎي آﻣﺎري ﺑﺎ ﻧﺮم اﻓﺰار آﻣﺎري 16 SPSS و ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮنﻫﺎي آﻣﺎري ﮐﺎي دو، T ﻣﺴﺘﻘﻞ و ﺿﺮﯾﺐ ﻫﻤﺒﺴﺘﮕﯽ ﭘﯿﺮﺳﻮن ﺻﻮرت ﮔﺮﻓﺖ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺷﮑﺴﺘﮕﯽ دﻧﺪه ﺷﺎﻣﻞ ﭘﻮﺳﺘﺮوﻟﺘﺮال در 128 ﻣﻮرد )69/6%( و ﻟﺘﺮال در 56 ﻣﻮرد )30/4%( و ﻧﯿﺰ از ﻧﻈﺮ ﻣﺤﻞ ﺑﻪ ﺻﻮرت ﻓﻮﻗﺎﻧﯽ در 8 ﺑﯿﻤﺎر )4/3%(، ﻣﯿﺎﻧﯽ در 170 ﺑﯿﻤﺎر )92/4%( و ﺗﺤﺘﺎﻧﯽ در 6 ﺑﯿﻤﺎر )3/3%( ﺑﻮد. ﺑﯿﻤﺎران ﺑﺎ ﺷﮑﺴﺘﮕﯽ ﭘﻮﺳﺘﺮوﻟﺘﺮال ﺑﻪ ﻃﻮر ﺑﺎرزي ﻣﯿﺰان ﻋﻮارض ﺑﯿﺸﺘﺮي داﺷﺘﻨﺪ ﮐﻪ ﻣﻨﺠﺮ ﺑﻪ اﻧﺘﻮﺑﺎﺳﯿﻮن و ﻣﺮاﻗﺒﺖﻫﺎي وﯾﮋه ﺑﯿﺸﺘﺮ، اﻣﺘﯿﺎز ISS ﺑﺎﻻﺗﺮ ﺷﺪه و ﺑﺎ ﺷﮑﺴﺘﮕﯽ ﻟﮕﻦ و ﮐﻼوﯾﮑﻮل ﻫﻤﺮاه ﺑﻮدﻧﺪ. ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻓﻮﻗﺎﻧﯽ در ﻣﻘﺎﯾﺴﻪ ﺑﺎ دﻧﺪهﻫﺎي ﻣﯿﺎﻧﯽ و ﺗﺤﺘﺎﻧﯽ ﻣﯿﺰان ﺑﺎﻻﺗﺮ ﻧﯿﺎز ﺑﻪ اﻧﺘﻮﺑﺎﺳﯿﻮن )0/001 = P و 0/04 = P(، ﺗﺮوﻣﺎي ﮔﺮدﻧﯽ )0/001=P و 0/01 = P( و ﻣﺪت ﺑﺴﺘﺮي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ ﻃﻮﻻﻧﯽﺗﺮ )0/001 < P ﺑﺮاي ﻫﺮ دو( و ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﺗﺤﺘﺎﻧﯽ در ﻣﻘﺎﯾﺴﻪ ﺑﺎ ﺷﮑﺴﺘﮕﯽﻫﺎي ﻣﯿﺎﻧﯽ و ﻓﻮﻗﺎﻧﯽ ﺑﻄﻮر ﺑﺎرزي ﻣﯿﺰان ﺗﺮوﻣﺎي ﺷﮑﻤﯽ )0/001 < P و 0/015 = P( و ﺷﮑﺴﺘﮕﯽ ﻣﻬﺮهﻫﺎي ﻏﯿﺮ ﻣﺠﺎور )0/001 < P و 0/015 = P( ﺑﯿﺸﺘﺮي داﺷﺘﻨﺪ. ارﺗﺒﺎط ﻣﺜﺒﺖ ﻣﻌﻨﺎدار ﺑﯿﻦ ﺗﻌﺪاد دﻧﺪهﻫﺎي ﺷﮑﺴﺘﻪ و ﻣﺪت ﺑﺴﺘﺮي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ )0/001 < P و 0/328 =R ( و ﻣﺪت ﺑﺴﺘﺮي در P = 0/01) ICU و 0/363 = R( ﻣﺸﺎﻫﺪه ﮔﺮدﯾﺪ. ﻫﯿﭻ ﻋﺎرﺿﻪاي ﻃﯽ دو ﻣﺎه ﭘﯿﮕﯿﺮي ﻣﺸﺎﻫﺪه ﻧﺸﺪ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺷﮑﺴﺘﮕﯽ دﻧﺪهﻫﺎي ﻓﻮﻗﺎﻧﯽ ﺑﺎ ﺗﺮوﻣﺎي ﺷﺪﯾﺪﺗﺮ ﻫﻤﺮاه ﺑﻮده و ﻧﯿﺎزﻣﻨﺪ ﺑﺴﺘﺮي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ و ﻣﺮاﻗﺒﺖ ICU ﺑﯿﺸﺘﺮ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻋﻮارض ﻣﺪﯾﮑﺎل و ﺟﺮاﺣﯽ ﺑﯿﺸﺘﺮ ﻣﯽﺑﺎﺷﻨﺪ. ﻣﯿﺰان ﻋﻮارض )ﻣﻮرﺑﯿﺪﯾﺘﯽ( در ﺷﮑﺴﺘﮕﯽﻫﺎي ﭘﻮﺳﺘﺮوﻟﺘﺮال ﺑﯿﺸﺘﺮ ﺑﻮده و اﯾﻦ ﺑﯿﻤﺎران ﻣﺮاﻗﺒﺖ ﭘﺰﺷﮑﯽ ﺑﯿﺸﺘﺮي ﻧﯿﺎز دارﻧﺪ.

Introduction & Objective: Thoracic trauma is one of the leading causes of morbidity and mortality in trauma patients and rib fracture due to blunt trauma to the chest wall, is the most common etiology. This study analyzed the correlation between rib fracture and prognosis of multiple trauma patients. Materials & Methods: One hundred eighty four trauma patients suffering from rib fracture due to blunt trauma were studied. Demographic data, injury characteristics, rib fracture characteristics as well as associated injuries and injury severity score (ISS) were recorded. Rib fracture was classified according to location (left, right, and bilateral), and level (upper rib fracture [1-2nd rib], middle rib fracture [3-8th rib], and lower rib fracture [9-12th rib]), also categorized as lateral and posterolateral. Results: Rib fracture was posterolateral (69.6%) and lateral (30.4%), upper (4.3%), middle (92.4%) and lower (3.3%). Patients with posterolateral fracture had significantly more complications which led to airway intubation and more intensive care support, higher ISS and associated with pelvic and clavicular fracture. Upper rib fractures were associated with more length-of-stay (LOS) and lower rib fractures with more abdominal trauma and lumbar/thoracolumbar vertebral fractures. A significantly positive correlation was seen between number of fractured ribs and ISS, hospital and ICU LOS. There were no complications during 2 months follow-up. Conclusions: Upper ribs’ fractures are associated with severe trauma, and require more hospitalization and ICU support considering more surgical and medical complications. Morbidity is higher in Posterolateral fractures and the patients need more medical care