Clinical effect of non-operative versus operative treatment for flail chest / 中华创伤杂志

ABSTRACT

Objective To compare the clinical effect of non-operative and operative treatment for flail chest.Methods A retrospective case control study was made on 60 cases of flail chest treated from March 2013 to April 2016.There were 42 males and 18 females,at the age range of 36-62 years [(49.8 ± 10.3)years].According to the treatment methods,the patients were divided into non-operation group (28 cases) and operation group (32 cases).Chest CT,pulmonary function and 36-item short-form health survey(SF-36) were measured in all patients 3 months and 6 months after injury.Differences in atelectasis,chest wall deformity,delayed fracture healing,pulmonary function and life quality were analyzed between the two groups.Results Compared to non-operative group at postoperative 3 months,rates of atelectasis,chest wall deformity and delayed fracture healing in operation group were obviously lower,while indices of pulmonary function pulmonary function including forced vital capacity (FVC),forced expiratory volume in one second(FEV1),one second rate (FEV1/FVC) and maximal voluntary ventilation measured value (MVV) in operation group wcre higher,and SF-36 parameters including physical functioning (PF),role-physical (RP),bodily pain (BP),general health (GH),vitality (VT),social functioning (SF) and mental health (MH) in operation group were better (all P ＜ 0.05).As to the data measured 6 months after injury,there were no significant differences between the two groups,except that the rate of chest wall deformity in non-operative group (6 cases,39％) was higher than that in operation group (11 cases,19％) (P ＜ 0.05).As to c hest CT,indices of pulmonary function and SF-36 parameters (P ＜ 0.05),there were no significant differences within operation group at postoperative 3 months and 6 months (P ＞ 0.05).Non-operation group showed better results in rate of atelectasis,rate of delayed fracture healing,indices of pulmonary function and SF-36 parameters measured 6 months after injury than the detections at postoperative 3 months (P ＜ 0.05),without difference in rate of chest wall deformity (P ＞ 0.05).Conclusions Surgical treatment of flail chest can accelerate fracture healing,reduce rate of chest wall deformity and improve life quality of patients early compared to non-operative treatment.Although there is no obvious difference in life quality of patients between operative and non-operative treatment 6 months after injury,but the chest wall deformity remains significantly different.