Surgical treatment ofpatients with severe non-flail chest rib fractures

doi:10.12998/wjcc.v7.i22.3718

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Nov 26, 2019 (publication date) through Feb 21, 2025

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World Journal of Clinical Cases

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2307-8960

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Clin Cases. Nov 26, 2019; 7(22): 3718-3727
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3718

Table 1 Comparison of clinical data between the two groups of patients, n (%)

Clinical information	Surgery group (n = 39)	Conservative group (n = 39)	P value
Sex			0.071
Male	28	29
Female	11	10
Age	48.7 (9.6)	50.2 (10.1)	0.059
Rib fracture (root)	5.1 (1.3)	4.9 (1.2)	0.057
Rib fracture	5.6 (1.4)	5.4 (1.4)	0.054
Chest associated injury			0.065
Pulmonary contusion	27	25
Simple blood chest	15	14
Blood pneumothorax	8	6
Average chest cumulative AIS¹	3	3	0.985
Chest injury²			0.073
Clavicle and upper limb fracture	5	5
Mild brain injury	2	3
Hepatic contusion	1	1
Spleen contusion	0	1
Tobacco use	16	15	0.075

¹Chest cumulative abbreviated injury scale (AIS) refers to the sum of the AIS scores on the chest.

²Mild brain injury indicates a score of 13-15 points on the Glasgow Coma scale. The remaining abbreviated injury scale scores were ≤ 2 points. AIS: Abbreviated injury scale.

Table 2 Parameters related to surgery for the surgical group

Surgical parameter	mean ± SD
Fixed	4.744 ± 0.715
Total incision length (cm)	7.667 ± 1.143
Operation time (min)	60.385 ± 14.345
Intraoperative bleeding (mL)	38.461 ± 21.094
Time to chest wall drainage extraction (h)	30.769 ± 9.045
Thoracic + chest wall drainage (mL)	168.462 ± 54.413
Time to chest drainage extraction(h)	34.154 ± 8.937

Table 3 Comparison of SF-36 scores between the surgical group and the conservative group

Dimension	Surgery group (n = 39)	Conservative group (n = 39)	Z/t	P value
PF
Postoperative 3 mo	52.44 (6.77,60.00)	50.00 (50.00,50.00)	-1.810	0.070
Postoperative 6 mo	65.00 (65.00,70.00)^d	55.00 (50.00,55.00)^d	-6.850	0.000^b
RP
Postoperative 3 mo	25.00 (0.00,50.00)	25.00 (0.00,25.00)	-2.019	0.043^a
Postoperative 6 mo	25.00 (25.00,50.00)^d	25.00 (0.00,25.00)^d	-3.380	0.001^b
BP
Postoperative 3 mo	52.00 (41.00,52.00)	41.00 (31.00,52.00)	-2.829	0.005^b
Postoperative 6 mo	62.00 (52.00,74.00)^d	41.00 (31.00,52.00)^d	-5.386	0.000^b
GH
Postoperative 3 mo	60.00 (50.00,65.00)	55.00 (45.00,65.00)	-2.071	0.038^a
Postoperative 6 mo	72.00 (65.00,72.00)^d	55.00 (50.00,65.00)^d	-5.838	0.000^b
VT
Postoperative 3 mo	50.00 (45.00,55.00)	40.00 (35.00,45.00)	-3.922	0.000^b
Postoperative 6 mo	60.00 (55.00,60.00)^d	45.00 (45.00,50.00)^d	-6.960	0.000^b
SF
Postoperative 3 mo	62.50 (62.50,62.50)	62.50 (50.00,62.50)	-3.092	0.002^b
Postoperative 6 mo	75.00 (62.50,75.00)^d	62.50 (50.00,62.50)^d	-5.259	0.000^b
RE
Postoperative 3 mo	33.33 (33.33,33.33)	0.00 (0.00,33.33)	-3.983	0.000^b
Postoperative 6 mo	66.70 (33.33,66.70)^d	33.33 (0.00,33.33)^d	-4.940	0.000^b
MH
Postoperative 3 mo	56.00 (52.00,60.00)	52.00 (48.00,56.00)	-3.199	0.001^b
Postoperative 6 mo	64.00 (60.00,64.00)^d	52.00 (52.00,56.00)^d	-6.810	0.000^b
SF-36 total score
Postoperative 3 mo	393.57 ± 68.51	335.12 ± 83.11	3.389	0.001^b
Postoperative 6 mo	493.07 ± 69.97^d	363.64 ± 72.02^d	8.050	0.000^b

^aP<0.05, Surgery groupvsconservative group.

^bP<0.01, Surgery groupvsconservative group.

^dP<0.05, preoperative results vs 3 mo after treatment. PF: Physical functioning; BP: Bodily pain; RP: Physical role functioning; GH: General health; VT: Vitality; SF: Social functioning; RE: Emotional functioning; MH: Mental health.

Table 4 Comparison of preoperative pain score and postoperative pain score at 24 h in the surgical group

	VA score	t	P value
Highest preoperative pain	6.51 (0.60)	9.064	< 0.01
Postoperative pain score at 24 h	5.48 (0.64)	9.064	< 0.01

Table 5 Pairs of pain scores at different time points in the two groups

Time	Surgical group	Conservative group
The highest score of preoperative pain (the highest pain score within 72 h after injury)	6.51 (0.60)	6.31 (0.57)
Pain score at 72 h postoperatively (pain score 1wk after injury)	3.95 (0.72)^d	5.46 (0.55)^a^d
Pain score at 2wk after surgery (2 wk pain score after injury)	2.95 (0.39)^d	4.67 (0.53)^a^d
Pain score at 4wk after surgery (4 wk post-injury pain score)	2.54 (0.51)^d	3.92 (0.48)^a^d
Pain score at 6wk after surgery (6 wk post-injury pain score)	1.87 (0.34)^d	3.33 (0.48)^a^d
Pain score at 3 mo after surgery (pain score after 3 mo)	0.90 (0.45)^d	2.92 (0.27)^a^d
Pain score at 6 mo postoperatively (pain score after 6 mo)	0.36 (0.49)^d	2.05 (0.65)^a^d

^aP < 0.05vsthe surgery group.

^dP < 0.05 vs the highest preoperative pain score.

Citation: Zhang JP, Sun L, Li WQ, Wang YY, Li XZ, Liu Y. Surgical treatment ofpatients with severe non-flail chest rib fractures. World J Clin Cases 2019; 7(22): 3718-3727
URL: https://www.wjgnet.com/2307-8960/full/v7/i22/3718.htm
DOI: https://dx.doi.org/10.12998/wjcc.v7.i22.3718