Multipl kot kırıklarında kot stabilizasyonu ve konservatif tedavinin etkinliğinin karşılaştırılması

Öz

Giriş: Yelken göğüse neden olmayan multipl kot kırıkları için cerrahi endikasyonlar konusunda küresel bir kılavuz veya fikir birliği yoktur. Çalışmadaki amacımız, yelken göğüs dışı nedenlerle kot stabilizasyonu uygulanan hastalar ile konservatif tedavi uygulanan hastaların sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: 2010 Ocak ile 2021 Aralık ayı arasında künt travma sonrası kliniğimize başvuran, multipl kot kırığı saptanan 53 hasta çalışmaya dahil edildi. Kot stabilizasyonu yapılan hastalar grup 1, konservatif tedavi uygulanan hastalar ise grup 2 olarak kabul edildi. İki grup yaş, cinsiyet, travma nedeni, fraktür sayısı, eşlik eden pulmoner yaralanmalar, eşlik eden toraks dışı yaralanmalar, tüp torakostomi takip süresi, intravenöz analjezik kullanım süresi, kan transfüzyon miktarı, hemoglobin düzeyinde azalma miktarı, yoğun bakım yatış süresi, hastane yatış süresi, pulmoner komplikasyonlar ve mortalite açısından karşılaştırıldı. Bulgular: Kot stabilizasyonu uygulanan 17 hastada cerrahi endikasyonlar: 6 hastada parankim yaralanması ve masif hava kaçağı, 5 hastada clotted hemotoraks ve akciğer ekspansiyon kusuru, 3 hastada deplase segmentin 15 mm’den fazla olduğu multipl kot kırığı, 2 hastada intravenöz analjezik tedaviye rağmen şiddetli ağrı ve 1 hastada göğüs kafesinde volüm kaybına neden olan multipl kot kırığı idi. Kot stabilizasyonu yapılan hastalar ile yapılmayanlar arasında intravenöz analjezik kullanım süresi, yoğun bakım ve hastane yatış süresi açısından anlamlı fark vardı. Ancak tüp torakostomi takip süresi, kan transfüzyon miktarı, hemoglobin düzeyinde düşme miktarı, pulmoner komplikasyon ve mortalite açısından anlamlı fark saptanmadı. Sonuç: Multipl kot kırıklarının cerrahi stabilizasyonu intravenöz analjezik kullanım süresi, yoğun bakım ve hastane yatış süresini azaltan güvenli ve etkili bir prosedürdür.

Anahtar Kelimeler

• Kot kırıkları
• Kot stabilizasyonu
• Konservatif tedavi

Comparison of the efficacy of rib stabilization and conservative treatment in multiple rib fractures

Abstract

Objective: There is no global guideline or consensus on surgical indications for multiple rib fractures that do not cause flail chest. Our aim in the study is to compare the results of patients who underwent rib stabilization for reasons other than flail chest and those who received conservative treatment. Materials and Methods: 53 patients with multiple rib fractures who applied to our clinic after blunt trauma between January 2010 and December 2021 were included in the study. The patients who underwent rib stabilization were accepted as group 1, and the patients who underwent conservative treatment were considered as group 2. Two groups age, gender, cause of trauma, number of fractures, accompanying pulmonary injuries, accompanying extrathoracic injuries, tube thoracostomy follow-up time, duration of intravenous analgesic use, amount of blood transfusion, amount of decrease in hemoglobin level, length of intensive care unit stay, length of hospital stay, pulmonary complications and mortality were compared. Results: Indications for surgery in 17 patients who underwent rib stabilization: parenchymal injury and massive air leak in 6 patients, clotted hemothorax and lung expansion defect in 5 patients, multiple rib fractures of the displaced segment greater than 15 mm in 3 patients, severe pain despite intravenous analgesic therapy in 2 patients, and multiple rib fractures causing volume loss in the thorax in 1 patient. There was a significant difference between the patients who had rib stabilization and those who did not, in terms of duration of intravenous analgesic use, intensive care unit and hospital stay. However, no significant difference was found in terms of tube thoracostomy follow-up time, blood transfusion amount, decrease in hemoglobin level, pulmonary complications and mortality. Conclusion: Surgical stabilization of multiple rib fractures is a safe and effective procedure that reduces the duration of intravenous analgesic use, length of intensive care unit and hospital stay.

Keywords

• Rib fractures
• Rib stabilization
• Conservative treatment

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