Rippenosteosynthesen – funktionsverbessernd?

Zusammenfassung

Diese Übersicht vergleicht anhand der aktuellen Literatur funktionelle Ergebnisse nach operativer und konservativer Therapie bei Patienten mit instabilem Thorax und Rippenserienfrakturen. Unter funktionellen Gesichtspunkten profitieren Patienten vor allem in der frühen Phase nach einem Thoraxtrauma von einer Rekonstruktion der Brustwand durch Rippenosteosynthesen. Schneller als bei konservativ behandelten Patienten bilden sich restriktive Ventilationsstörungen und Schmerzen zurück. Operierte Patienten nehmen früher wieder ihre Arbeit auf. Mittelfristig erreichen Patienten aber auch ohne eine Operation normale Lungenfunktionswerte und werden schmerzfrei. Die Dauer der Rekonvaleszenz nach stumpfen Thoraxtraumata wird generell unterschätzt. Zukünftige Untersuchungen der funktionellen Ergebnisse nach schweren Thoraxverletzungen sollten dies berücksichtigen und die Entwicklung funktioneller Parameter über mindestens 24 Monate verfolgen. Eine prospektive Erfassung von Früh- und Langzeitergebnissen in Registern würde sich eignen, um den Nutzen und die Indikationen für die Rippenosteosynthese zu bewerten.

Abstract

This overview reviews the current literature to compare the functional results after surgical and conservative treatment of patients with flail chest and multiple rib fractures. Regarding functional aspects, patients in the early phase after a thoracic trauma are those that benefit most from the stabilisation of the chest wall by internal fixation of the ribs. Patients recover faster from restrictive respiratory disorders, have less pain and return to the workplace earlier after an operation compared with those that receive conservative treatment. In the medium term, however, patients that are treated conservatively also achieve normal pulmonary function values and become free of pain. The period of convalescence after blunt thoracic trauma is generally underestimated. Future studies of the functional outcome after severe chest injuries should take this into account and the development of functional parameters should be monitored for at least 24 months. A prospective data collection of early and long-term surgical results in registries would be suitable to evaluate benefits and indications of chest wall stabilisation.

Schlüsselwörter

Rippenfraktur - instabiler Thorax - Brustwandstabilisierung - funktionelles Ergebnis

Key words

rib fracture - flail chest - functional outcome - chest wall stabilisation

• Literatur

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