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Abstract：
BACKGROUND: Chest wall reconstruction was introduced for the management of patients with severe chest wall injuries. We undertook a retrospective cohort study to investigate whether the treatment was associated with improved survival compared with conservative treatment.
METHODS: A retrospective single institutional cohort study compared mortality following treatment of major chest wall trauma (Abbreviated Injury Scale ≥3) by chest wall reconstruction (CWR) to conservative management (Non-CWR) between September 2014 and December 2019. Univariable and multivariable associations between demographic and comorbid characteristics and mortality were estimated using Cox proportional hazard analysis and expressed as hazard ratios (HR) and corresponding confidence intervals (CI).
RESULTS: Of a cohort of 947, CWR (n=157, 16.6%) had a lower prevalence of polytrauma (35.7 vs 56.3%, p<0.001) and head injury (11.5% vs 26.7%, p<0.001). CWR-treated patients experienced a greater number of fractured ribs, (8.3 vs 5.8, p<0.001), higher incidence of flail chest (84.9% vs 48.9%, p<0.001), higher admission to Critical Care (64.3% vs 44.1%, p<0.001), greater demand for ventilation (36.9% vs 25.6%, p=0.004) and a higher New Injury Severity Scale value (36.9 vs 34.6, p=0.003). Mortality of CWR patients was significantly lower (3.8% vs 8.6%, p=0.04), with adjusted HR 0.30 (95% CI 0.12, 0.72, p=0.008).
CONCLUSIONS: Chest wall reconstructive surgery, provided as a part of multidisciplinary treatment strategy for major thoracic trauma, reduces risk of mortality. The results validate the UK Government strategy, designed to reduce mortality, by centralising management of serious trauma in Major Trauma Centres.
METHODS: A retrospective single institutional cohort study compared mortality following treatment of major chest wall trauma (Abbreviated Injury Scale ≥3) by chest wall reconstruction (CWR) to conservative management (Non-CWR) between September 2014 and December 2019. Univariable and multivariable associations between demographic and comorbid characteristics and mortality were estimated using Cox proportional hazard analysis and expressed as hazard ratios (HR) and corresponding confidence intervals (CI).
RESULTS: Of a cohort of 947, CWR (n=157, 16.6%) had a lower prevalence of polytrauma (35.7 vs 56.3%, p<0.001) and head injury (11.5% vs 26.7%, p<0.001). CWR-treated patients experienced a greater number of fractured ribs, (8.3 vs 5.8, p<0.001), higher incidence of flail chest (84.9% vs 48.9%, p<0.001), higher admission to Critical Care (64.3% vs 44.1%, p<0.001), greater demand for ventilation (36.9% vs 25.6%, p=0.004) and a higher New Injury Severity Scale value (36.9 vs 34.6, p=0.003). Mortality of CWR patients was significantly lower (3.8% vs 8.6%, p=0.04), with adjusted HR 0.30 (95% CI 0.12, 0.72, p=0.008).
CONCLUSIONS: Chest wall reconstructive surgery, provided as a part of multidisciplinary treatment strategy for major thoracic trauma, reduces risk of mortality. The results validate the UK Government strategy, designed to reduce mortality, by centralising management of serious trauma in Major Trauma Centres.
摘要：
背景：胸壁重建术用于严重胸壁损伤患者的治疗。我们进行了一项回顾性队列研究，以调查与保守治疗相比，该治疗是否与改善生存率相关。
方法：一项回顾性单机构队列研究比较了2014年9月至2019年12月期间通过胸壁重建（CWR）与保守治疗（Non-CWR）治疗严重胸壁创伤（缩写损伤量表≥3）后的死亡率。使用Cox比例风险分析估计人口统计学和合并症特征与死亡率之间的单变量和多变量关联，并表示为风险比（HR）和相应的置信区间（CI）。
结果：在947个队列中，CWR（n=157，16.6％）的多发伤患病率较低（35.7vs56.3％，p<0.001）和头部受伤（11.5%vs26.7%，p<0.001)。CWR治疗的患者经历了更多的肋骨骨折，（8.3vs5.8，p<0.001），连ail胸的发病率较高(84.9%vs48.9%，p<0.001)，重症监护入院率较高(64.3%vs44.1%，p<0.001)，对通风的需求增加(36.9%对25.6%，p=0.004）和更高的新伤害严重程度量表值（36.9vs34.6，p=0.003）。CWR患者的死亡率显着降低（3.8％vs8.6％，p=0.04),调整后的HR0.30（95%CI0.12，0.72，p=0.008）。
结论：胸壁重建手术，作为主要胸部创伤的多学科治疗策略的一部分，降低死亡风险。结果验证了英国政府的战略，旨在降低死亡率，通过在主要创伤中心集中管理严重创伤。
方法：一项回顾性单机构队列研究比较了2014年9月至2019年12月期间通过胸壁重建（CWR）与保守治疗（Non-CWR）治疗严重胸壁创伤（缩写损伤量表≥3）后的死亡率。使用Cox比例风险分析估计人口统计学和合并症特征与死亡率之间的单变量和多变量关联，并表示为风险比（HR）和相应的置信区间（CI）。
结果：在947个队列中，CWR（n=157，16.6％）的多发伤患病率较低（35.7vs56.3％，p<0.001）和头部受伤（11.5%vs26.7%，p<0.001)。CWR治疗的患者经历了更多的肋骨骨折，（8.3vs5.8，p<0.001），连ail胸的发病率较高(84.9%vs48.9%，p<0.001)，重症监护入院率较高(64.3%vs44.1%，p<0.001)，对通风的需求增加(36.9%对25.6%，p=0.004）和更高的新伤害严重程度量表值（36.9vs34.6，p=0.003）。CWR患者的死亡率显着降低（3.8％vs8.6％，p=0.04),调整后的HR0.30（95%CI0.12，0.72，p=0.008）。
结论：胸壁重建手术，作为主要胸部创伤的多学科治疗策略的一部分，降低死亡风险。结果验证了英国政府的战略，旨在降低死亡率，通过在主要创伤中心集中管理严重创伤。
