Abstract：
BACKGROUND: Surgical stabilization of rib fractures (SSRF) using standard rib plating systems has become a norm in developed countries. However, the procedure has not garnered much interest in low-middle-income countries, primarily because of the cost.
METHODS: This was a single-center pilot randomized trial. Patients with severe rib fractures were randomized into two groups: SSRF and nonoperative management. SSRF arm patients underwent surgical fixation in addition to the tenets of nonoperative management. Low-cost materials like stainless steel wires and braided polyester sutures were used for fracture fixation. The primary outcome was to assess the duration of hospital stay.
RESULTS: Twenty-two patients were randomized, 11 in each arm. Per-protocol analysis showed that the SSRF arm had significantly reduced duration of hospital stay (22.6 ± 19.1 d versus 7.9 ± 5.7 d, P value 0.031), serial pain scores at 48 h and 5 d (median score 5, IQR (3-6) versus median score 7, IQR (6.5-8), P value 0.004 at 48 h and median score 2 IQR (2-3) versus median score 7 IQR (4.5-7) P value 0.0005 at 5 d), significantly reduced need for injectable opioids (9.9 ± 3.8 mg versus 4.4 ± 3.4 mg, P value 0.003) and significantly more ventilator-free days (19.9 ± 8.7 d versus 26.4 ± 3.2 d, P value 0.04). There were no statistically significant differences in the total duration of ICU stay (median number of days 2, IQR 1-4.5 versus median number of days 7, IQR 1-14, P value 0.958), need for tracheostomy (36.4% versus 0%, P value 0.155), and pulmonary and pleural complications.
CONCLUSIONS: SSRF with low-cost materials may provide benefits similar to standard rib plating systems and can be used safely in resource-poor settings.
METHODS: This was a single-center pilot randomized trial. Patients with severe rib fractures were randomized into two groups: SSRF and nonoperative management. SSRF arm patients underwent surgical fixation in addition to the tenets of nonoperative management. Low-cost materials like stainless steel wires and braided polyester sutures were used for fracture fixation. The primary outcome was to assess the duration of hospital stay.
RESULTS: Twenty-two patients were randomized, 11 in each arm. Per-protocol analysis showed that the SSRF arm had significantly reduced duration of hospital stay (22.6 ± 19.1 d versus 7.9 ± 5.7 d, P value 0.031), serial pain scores at 48 h and 5 d (median score 5, IQR (3-6) versus median score 7, IQR (6.5-8), P value 0.004 at 48 h and median score 2 IQR (2-3) versus median score 7 IQR (4.5-7) P value 0.0005 at 5 d), significantly reduced need for injectable opioids (9.9 ± 3.8 mg versus 4.4 ± 3.4 mg, P value 0.003) and significantly more ventilator-free days (19.9 ± 8.7 d versus 26.4 ± 3.2 d, P value 0.04). There were no statistically significant differences in the total duration of ICU stay (median number of days 2, IQR 1-4.5 versus median number of days 7, IQR 1-14, P value 0.958), need for tracheostomy (36.4% versus 0%, P value 0.155), and pulmonary and pleural complications.
CONCLUSIONS: SSRF with low-cost materials may provide benefits similar to standard rib plating systems and can be used safely in resource-poor settings.
摘要：
背景：使用标准肋骨板系统进行肋骨骨折（SSRF）的手术稳定已成为发达国家的规范。然而,这一程序在中低收入国家没有引起太大的兴趣，主要是因为成本。
方法：这是一项单中心随机试验。严重肋骨骨折患者被随机分为两组：SSRF和非手术治疗。除了非手术治疗的原则外，SSRF手臂患者还接受了手术固定。低成本材料，如不锈钢丝和编织聚酯缝线用于骨折固定。主要结果是评估住院时间。
结果：22例患者被随机分组，每个手臂11。按方案分析显示，SSRF组的住院时间显着减少（22.6±19.1d对7.9±5.7d，P值0.031),48h和5d的连续疼痛评分（中位数评分5，IQR（3-6）与中位数评分7，IQR（6.5-8），48h时的P值0.004，中位数评分2IQR（2-3）与中位数评分7IQR（4.5-7）在5d时的P值0.0005），对可注射阿片类药物的需求显着减少（9.9±3.8mg与4.4±3.4mg，P值0.003），并且无呼吸机天数显着增加（19.9±8.7d对26.4±3.2d，P值0.04)。ICU住院总时间差异无统计学意义(中位天数2,IQR1-4.5与中位天数7,IQR1-14,P值0.958),需要气管造口术(36.4%对0%，P值0.155),肺和胸膜并发症。
结论：具有低成本材料的SSRF可能提供类似于标准肋骨电镀系统的好处，并且可以在资源贫乏的环境中安全使用。
方法：这是一项单中心随机试验。严重肋骨骨折患者被随机分为两组：SSRF和非手术治疗。除了非手术治疗的原则外，SSRF手臂患者还接受了手术固定。低成本材料，如不锈钢丝和编织聚酯缝线用于骨折固定。主要结果是评估住院时间。
结果：22例患者被随机分组，每个手臂11。按方案分析显示，SSRF组的住院时间显着减少（22.6±19.1d对7.9±5.7d，P值0.031),48h和5d的连续疼痛评分（中位数评分5，IQR（3-6）与中位数评分7，IQR（6.5-8），48h时的P值0.004，中位数评分2IQR（2-3）与中位数评分7IQR（4.5-7）在5d时的P值0.0005），对可注射阿片类药物的需求显着减少（9.9±3.8mg与4.4±3.4mg，P值0.003），并且无呼吸机天数显着增加（19.9±8.7d对26.4±3.2d，P值0.04)。ICU住院总时间差异无统计学意义(中位天数2,IQR1-4.5与中位天数7,IQR1-14,P值0.958),需要气管造口术(36.4%对0%，P值0.155),肺和胸膜并发症。
结论：具有低成本材料的SSRF可能提供类似于标准肋骨电镀系统的好处，并且可以在资源贫乏的环境中安全使用。
