背景:需要手术干预的创伤性乳房损伤是罕见且未完全研究的。研究目的是确定发病率,损伤机制/负担,干预措施,以及需要在全国范围内进行手术的乳房损伤后的结果。
方法:从国家创伤数据库(NTDB)(2006-2017)使用ICD-9和-10代码确定所有需要手术的乳房创伤患者,没有排除。人口统计,损伤机制/严重程度,程序,和结果(死亡率,住院时间[LOS,days],ICULOS,和AIS>1在>1个身体区域,定义多系统创伤)与方差分析或卡方检验进行比较,视情况而定。
结果:总计,899名患者(NTDB的.01%)符合研究标准。中位年龄为41岁,大多数患者为女性(n=802,89%)。穿透性创伤是最常见的损伤机制(n=395,44%),其次是钝伤(n=369,41%)和烧伤(n=135,15%)。钝性创伤后ISS中位数高于穿透性创伤或烧伤(10vs5vs4,P<.001)。在穿透性(n=354,90%)和钝性(n=265,72%)创伤患者中,裂伤修复/乳房切开术是最常见的手术,而乳房切除术是烧伤后最常见的(n=126,93%)。乳房手术因机制而异(P<.001)。
结论:需要手术的乳房损伤并不常见。大多数发生在穿透性创伤后,虽然钝性创伤后损伤严重程度最高,烧伤后死亡率最高。程序类型,损伤严重程度,结果因损伤机制而异,这意味着乳房外伤应该在损伤机制的背景下考虑。这些发现可能有助于乳房外伤后需要手术干预的预后。
BACKGROUND: Traumatic breast injuries that require surgical intervention are rare and incompletely studied. The study objective was to define the incidence, mechanism/burden of injury, interventions, and outcomes after breast injuries requiring surgery nationally.
METHODS: All patients with breast trauma necessitating surgery were identified from the National Trauma Data Bank (NTDB) (2006-2017) using ICD-9 and -10 codes, without exclusions. Demographics, injury mechanism/severity, procedures, and outcomes (mortality, hospital length of stay [LOS, days], ICU LOS, and AIS >1 in >1 body regions, defining multisystem trauma) were compared with ANOVA or Chi-squared tests, as appropriate.
RESULTS: In total, 899 patients (.01% of NTDB) met study criteria. Median age was 41 years and most patients were female (n = 802, 89%). Penetrating trauma was the most common injury mechanism (n = 395, 44%), followed by blunt trauma (n = 369, 41%) and burns (n = 135, 15%). Median ISS was higher after blunt trauma than penetrating trauma or burns (10 vs 5 vs 4, P < .001). Laceration repair/mastotomy was the most common procedure among penetrating (n = 354, 90%) and blunt (n = 265, 72%) trauma patients, while mastectomy was the most common after burns (n = 126, 93%). Breast procedures varied significantly by mechanism (P < .001).
CONCLUSIONS: Breast injuries requiring surgery are uncommon. Most occur following penetrating trauma, although injury severity is highest after blunt trauma and mortality is highest after burns. Procedure type, injury severity, and outcomes varied significantly by mechanism of injury, implying that breast trauma should be considered within the context of injury mechanism. These findings may assist with prognostication after breast trauma necessitating surgical intervention.