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肋骨骨折：修订间差异

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{{Infobox medical condition (new)
{{requested move|肋骨骨折|time=2022-07-12}}
| name = 肋骨骨折
<!-- 定義與症狀 -->
| synonyms =
⚫
'''肋骨骨折'''（{{lang-en|rib fracture}}），為發生在[[肋骨]]的[[骨折]]<ref name="Mos2013">{{cite book|title=Mosby's Medical Dictionary|format=E-Book|date=2013|publisher=Elsevier Health Sciences|isbn=978-0323112581|page=1567|url=https://books.google.com/books?id=aW0zkZl0JgQC&pg=PA1567|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013013051/https://books.google.ca/books?id=aW0zkZl0JgQC&pg=PA1567|archive-date=2017-10-13}}</ref>，常會隨著呼吸起伏而引起胸痛<ref name="Mos2013" />；骨折處可能出現[[瘀斑|瘀傷]]<ref name="Wanek04">{{cite journal|title=Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury|first1=Sandra|last2=Mayberry|first2=John C|journal=Critical Care Clinics|issue=1|doi=10.1016/S0749-0704(03)00098-8|year=2004|volume=20|pages=71–81|pmid=14979330|last1=Wanek}}</ref>。多根肋骨骨折時，可能會導致{{le|連枷胸|Flail chest}}。其潛在的併發症包含：[[氣胸]]、[[肺挫傷]]和[[肺炎]]等<ref name="May2015">{{cite journal|title=Rib fracture management|first1=L|last2=Hillermann|first2=C|date=January 2016|journal=BJA Education|issue=1|doi=10.1093/bjaceaccp/mkv011|volume=16|pages=26–32|last3=Patil|first3=S|last1=May|doi-access=free}}</ref><ref name="Mos2013" />。
| image = Fracturedribsmarked.jpg
| caption = 胸部X光片可以看到患者左胸紅圈處有多節陳舊性肋骨骨折
An X ray showing multiple old fractured ribs of the person's left side as marked by the oval.
| pronounce =
| field = [[急診醫學]]
| symptoms = 吸氣時疼痛加劇<ref name=Mos2013/>
| complications = [[肺挫伤]]、[[氣胸]]、[[肺炎]]<ref name=Mos2013/><ref name=May2015/>
| onset =
| duration =
| types =
| causes = [[胸部创伤]]<ref name=May2015/>
| risks =
| diagnosis = 症狀、[[醫學影像]]<ref name=Ad2012/>
| differential =
| prevention =
| treatment =
| medication = [[对乙酰氨基酚]]、[[非甾体抗炎药]]（NSAID）、[[鴉片類藥物]]<ref name=May2015/>
| prognosis = 疼痛症狀通常會在6周內改善<ref name=Ad2012/>
| frequency = 常見<ref name=May2015/>
| deaths =
}}
<!-- Definition and symptoms -->
⚫
'''肋骨骨折'''（{{lang-en|rib fracture}}），是指發生在[[肋骨]]的[[骨折]]<ref name=Mos2013>{{cite book|title=Mosby's Medical Dictionary |format= E-Book|date=2013|publisher=Elsevier Health Sciences|isbn=978-0323112581|page=1567|url=https://books.google.com/books?id=aW0zkZl0JgQC&pg=PA1567|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013013051/https://books.google.ca/books?id=aW0zkZl0JgQC&pg=PA1567|archive-date=2017-10-13}}</ref>，通常隨呼吸起伏而引起胸痛<ref name=Mos2013/>；骨折處可能出現[[淤斑|瘀傷]]<ref name=Ad2012>{{cite book|last1=Adams|first1=James G.|title=Emergency Medicine E-Book: Clinical Essentials (Expert Consult – Online)|date=2012|publisher=Elsevier Health Sciences|isbn=978-1455733941|page=682|url=https://books.google.com/books?id=rpoH-KYE93IC&pg=PA682|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013013053/https://books.google.ca/books?id=rpoH-KYE93IC&pg=PA682|archive-date=2017-10-13}}</ref>。若多根肋骨骨折時，可能導致{{le|連枷胸|Flail chest}}<ref name=Wanek04>{{cite journal |last1=Wanek |first1=Sandra |last2=Mayberry |first2=John C |title=Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury |journal=Critical Care Clinics |volume=20 |issue=1 |pages=71–81 |year=2004 |pmid=14979330 |doi=10.1016/S0749-0704(03)00098-8 }}</ref>。其潛在的併發症為[[氣胸]]、[[肺挫傷]]和[[肺炎]]等<ref name=May2015>{{cite journal|last1=May|first1=L|last2=Hillermann|first2=C|last3=Patil|first3=S|title=Rib fracture management|journal=BJA Education|date=January 2016|volume=16|issue=1|pages=26–32|doi=10.1093/bjaceaccp/mkv011|doi-access=free}}</ref><ref name=Mos2013/>。


<!-- 病因及診斷 -->
<!-- Cause and diagnosis -->
肋骨骨折常肇因於胸部遭受直接的鈍力傷害，如：遭遇[[車禍|交通事故、]]或發生{{le|輾壓傷|Crush injury}}<ref name="May2015" /><ref name="Mos2013" />，亦可能因為咳嗽或[[遠端轉移]]而導致<ref name="Mos2013" />。肋骨最常骨折的部位為中段肋骨<ref>{{Cite book|title=PET-CT: Rare Findings and Diseases|last=Nanni|first=Christina|publisher=Springer|year=2012|isbn=978-3-642-24698-2|page=257}}</ref><ref name="Mos2013" />；第一根或第二根肋骨骨折則最容易導致併發症<ref>{{cite journal|title=Rib Fracture Diagnosis in the Panscan Era.|url=https://escholarship.org/content/qt2b3582ws/qt2b3582ws.pdf?t=p0a17a|first1=4th|last2=Raja|first2=AS|date=27 May 2017|journal=Annals of Emergency Medicine|issue=6|doi=10.1016/j.annemergmed.2017.04.011|volume=70|pages=904–909|pmid=28559032|last3=Baumann|first3=BM|last4=Medak|first4=AJ|last5=Langdorf|first5=MI|last6=Nishijima|first6=DK|last7=Hendey|first7=GW|last8=Mower|first8=WR|last9=Rodriguez|first9=RM|s2cid=23442272|last1=Murphy CE}}</ref>。肋骨骨折的診斷，通常需根據臨床症狀、輔以[[醫學影像]]檢查<ref name="Ad2012">{{cite book|last1=Adams|first1=James G.|title=Emergency Medicine E-Book: Clinical Essentials (Expert Consult – Online)|date=2012|publisher=Elsevier Health Sciences|isbn=978-1455733941|page=682|url=https://books.google.com/books?id=rpoH-KYE93IC&pg=PA682|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013013053/https://books.google.ca/books?id=rpoH-KYE93IC&pg=PA682|archive-date=2017-10-13}}</ref>。
肋骨骨折通常肇因於患者胸部直接遭受鈍力傷害，例如遭遇[[車禍|交通事故]]或發生{{le|輾壓傷|Crush injury}}<ref name=May2015/><ref name=Mos2013/>，亦可能因為咳嗽或[[轉移性癌症|遠端轉移]]而導致<ref name=Mos2013/>。最常骨折的部位為中間的肋骨<ref>{{Cite book|title = PET-CT: Rare Findings and Diseases|last = Nanni|first = Christina|publisher = Springer|year = 2012|isbn = 978-3-642-24698-2|page = 257}}</ref><ref name=Mos2013/>；第一根或第二根肋骨骨折則是最常見有併發症發生<ref>{{cite journal|last1=Murphy CE|first1=4th|last2=Raja|first2=AS|last3=Baumann|first3=BM|last4=Medak|first4=AJ|last5=Langdorf|first5=MI|last6=Nishijima|first6=DK|last7=Hendey|first7=GW|last8=Mower|first8=WR|last9=Rodriguez|first9=RM|title=Rib Fracture Diagnosis in the Panscan Era.|journal=Annals of Emergency Medicine|date=27 May 2017|doi=10.1016/j.annemergmed.2017.04.011|pmid=28559032|volume=70|issue=6|pages=904–909|s2cid=23442272|url=https://escholarship.org/content/qt2b3582ws/qt2b3582ws.pdf?t=p0a17a}}</ref>。通常根據臨床症狀輔以[[醫學影像]]來診斷<ref name=Ad2012/>。


<!-- 盛行率及治療 -->
<!-- Treatment and epidemiology -->
[[疼痛管理]]為治療重要的一環<ref>{{cite journal|title=Patients with rib fractures: use of incentive spirometry volumes to guide care.|first1=SD|last2=Walters|first2=MR|date=2012|journal=Journal of Trauma Nursing|issue=2|doi=10.1097/JTN.0b013e31825629ee|volume=19|pages=89–91; quiz 92–03|pmid=22673074|last1=Brown|s2cid=45547470}}</ref>，其方法包含使用止痛藥，如：[[對乙醯胺基酚]]、[[非類固醇抗發炎藥]]或[[鴉片類藥物]]等<ref name="May2015" />；亦可以視情況施行{{le|神經阻斷術|nerve block}}<ref name="Mos2013" />。對於發生連枷胸的患者，安排手術有助於改善預後。<ref>{{cite journal|title=Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review.|first1=J|last2=Goslings|first2=JC|date=April 2017|journal=European Journal of Trauma and Emergency Surgery|issue=2|doi=10.1007/s00068-016-0721-2|volume=43|pages=163–68|pmc=5378742|pmid=27572897|last3=Schepers|first3=T|last1=Schuurmans}}</ref><ref>{{cite journal|title=Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials.|first1=TA|last2=Ng|first2=JW|date=August 2016|journal=The Bone & Joint Journal|issue=8|doi=10.1302/0301-620X.98B8.37282|volume=98-B|pages=1119–25|pmid=27482027|last3=Rollins|first3=KE|last4=Forward|first4=DP|last5=Ollivere|first5=BJ|last1=Coughlin}}</ref>
[[疼痛控制|疼痛管理]]為治療最重要的一環<ref>{{cite journal|last1=Brown|first1=SD|last2=Walters|first2=MR|title=Patients with rib fractures: use of incentive spirometry volumes to guide care.|journal=Journal of Trauma Nursing |date=2012|volume=19|issue=2|pages=89–91; quiz 92–03|doi=10.1097/JTN.0b013e31825629ee|pmid=22673074|s2cid=45547470}}</ref>，可能會採用[[對乙醯胺基酚]]、[[非類固醇抗發炎藥]]或[[鴉片類藥物]]<ref name=Mos2013/>。採用{{le|神經阻斷|nerve block}}也是一種方法<ref name=Mos2013/>。連枷胸的患者接受手術有助於改善預後<ref>{{cite journal|last1=Schuurmans|first1=J|last2=Goslings|first2=JC|last3=Schepers|first3=T|title=Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review.|journal=European Journal of Trauma and Emergency Surgery|date=April 2017|volume=43|issue=2|pages=163–68|doi=10.1007/s00068-016-0721-2|pmid=27572897|pmc=5378742}}</ref><ref>{{cite journal|last1=Coughlin|first1=TA|last2=Ng|first2=JW|last3=Rollins|first3=KE|last4=Forward|first4=DP|last5=Ollivere|first5=BJ|title=Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials.|journal=The Bone & Joint Journal|date=August 2016|volume=98-B|issue=8|pages=1119–25|doi=10.1302/0301-620X.98B8.37282|pmid=27482027}}</ref>。本疾病為常見的創傷傷害<ref>{{cite journal|last1=Senekjian|first1=L|last2=Nirula|first2=R|title=Rib Fracture Fixation: Indications and Outcomes.|journal=Critical Care Clinics|date=January 2017|volume=33|issue=1|pages=153–65|doi=10.1016/j.ccc.2016.08.009|pmid=27894495}}</ref>。
==參考資料==
==症狀==
典型的症狀為胸痛，通常吸氣時疼痛會加劇<ref name=Mos2013/>。骨折處亦可能出現[[瘀傷|淤斑]]<ref name=Ad2012/>。
{{reflist}}

⚫
[[:分類:骨折]]
===併發症===
⚫
[[:分類:外傷]]
有連續數根肋骨骨折時，可能導致{{le|連枷胸|Flail chest}}<ref name=Wanek04/>。潛在的併發症有[[氣胸]]、[[肺挫傷]]和[[肺炎]]<ref name=May2015/><ref name=Mos2013/>。==病因==
肋骨骨折可能是在從事休閒活動時，因遭受直接或間接的外力撞擊所導致。接受[[心肺復甦|心肺復甦術]]也會造成胸廓受傷，像是肋骨骨折、{{le|胸骨骨折|sternum fractures}}等；肋骨骨折也可能因患病所導致，例如罹患[[癌症]]或[[風濕性關節炎]]等病症。年長者可能因跌倒而導致肋骨骨折，但成人最常見的成因為發生車禍事故<ref>{{EMedicine|article|825981|Rib Fracture}}</ref>。

==診斷==
肋骨骨折的病徵如下<ref>{{Cite web|url = http://www.nhs.uk/conditions/rib-injuries/Pages/Introduction.aspx|title = Broken or bruised ribs|date = 2015|access-date = 15 August 2015|website = NHS.UK|url-status = live|archive-url = https://web.archive.org/web/20150820045022/http://www.nhs.uk/conditions/rib-injuries/Pages/Introduction.aspx|archive-date = 20 August 2015}}</ref>：
*吸氣時疼痛加劇

*胸部腫脹
*胸部瘀青
*呼吸短促
*咳血（可能是肋骨刺傷肺臟）

照[[X射線|X光]]可確定位移性骨折，但是往往容易忽略無位移的骨折<ref name=Den2017>{{cite journal |last1=Dennis |first1=BM |last2=Bellister |first2=SA |last3=Guillamondegui |first3=OD |title=Thoracic Trauma. |journal=The Surgical Clinics of North America |date=October 2017 |volume=97 |issue=5 |pages=1047–1064 |doi=10.1016/j.suc.2017.06.009 |pmid=28958357}}</ref>；以[[電腦斷層掃描|電腦斷層]]檢查可確定這兩種骨折<ref name=Den2017/>。
因為兒童的肋骨較成人有彈性，所以較可能彎曲而非直接折斷，因此當兒童患者發生肋骨骨折，代表其遭受劇烈的撞擊，同時也表示患者[[胸|胸部]]很可能有重大傷害，如發生[[肺挫傷|肺部挫傷]]<ref name=Wanek04/>。年長者會發生肋骨骨折，也表示曾遭受較嚴重的外傷<ref>{{Cite journal|title = Fatality Risk and the Presence of Rib Fractures|journal = Annals of Advances in Automotive Medicine / Annual Scientific Conference|date = 2008-01-01|issn = 1943-2461|pmc = 3256783|pmid = 19026224|pages = 73–84|volume = 52|first1 = Richard|last1 = Kent|first2 = William|last2 = Woods|first3 = Ola|last3 = Bostrom}}</ref>。

== 參見 ==
* {{tsl|en|Pulmonary hygiene|肺部清潔}}

== 參考文獻 ==
{{Reflist}}

== 外部連結 ==
{{Medical resources
| DiseasesDB = 11553
| ICD10 = {{ICD10|S|22|3|s|20}}-{{ICD10|S|22|4|s|20}}
| ICD9 = {{ICD9|807.0}}, {{ICD9|807.1}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = emerg
| eMedicineTopic = 204
| eMedicine_mult = {{eMedicine2|radio|609}}
| MeshID = D012253
}}

{{Scholia|topic}}
{{Fractures}}
{{Chest trauma}}

⚫
[[Category:骨折]]
⚫
[[Category:外伤]]

2022年7月12日 (二) 16:11的版本

肋骨骨折
胸部X光片可以看到患者左胸紅圈處有多節陳舊性肋骨骨折 An X ray showing multiple old fractured ribs of the person's left side as marked by the oval.
症状吸氣時疼痛加劇[1]
併發症肺挫伤、氣胸、肺炎[1][2]
病因胸部创伤[2]
診斷方法症狀、醫學影像[3]
藥物对乙酰氨基酚、非甾体抗炎药（NSAID）、鴉片類藥物[2]
预后疼痛症狀通常會在6周內改善[3]
患病率常見[2]
分类和外部资源
醫學專科急診醫學
ICD-11NA82.3
ICD-10S22.3、​S22.4
DiseasesDB11553
eMedicine825981
[编辑此条目的维基数据]

肋骨骨折（英語：rib fracture），是指發生在肋骨的骨折[1]，通常隨呼吸起伏而引起胸痛[1]；骨折處可能出現瘀傷[3]。若多根肋骨骨折時，可能導致連枷胸（英语：Flail chest）[4]。其潛在的併發症為氣胸、肺挫傷和肺炎等[2][1]。

肋骨骨折通常肇因於患者胸部直接遭受鈍力傷害，例如遭遇交通事故或發生輾壓傷（英语：Crush injury）[2][1]，亦可能因為咳嗽或遠端轉移而導致[1]。最常骨折的部位為中間的肋骨[5][1]；第一根或第二根肋骨骨折則是最常見有併發症發生[6]。通常根據臨床症狀輔以醫學影像來診斷[3]。

疼痛管理為治療最重要的一環[7]，可能會採用對乙醯胺基酚、非類固醇抗發炎藥或鴉片類藥物[1]。採用神經阻斷（英语：nerve block）也是一種方法[1]。連枷胸的患者接受手術有助於改善預後[8][9]。本疾病為常見的創傷傷害[10]。

症狀

典型的症狀為胸痛，通常吸氣時疼痛會加劇[1]。骨折處亦可能出現淤斑[3]。

併發症

有連續數根肋骨骨折時，可能導致連枷胸（英语：Flail chest）[4]。潛在的併發症有氣胸、肺挫傷和肺炎[2][1]。==病因== 肋骨骨折可能是在從事休閒活動時，因遭受直接或間接的外力撞擊所導致。接受心肺復甦術也會造成胸廓受傷，像是肋骨骨折、胸骨骨折（英语：sternum fractures）等；肋骨骨折也可能因患病所導致，例如罹患癌症或風濕性關節炎等病症。年長者可能因跌倒而導致肋骨骨折，但成人最常見的成因為發生車禍事故[11]。

診斷

肋骨骨折的病徵如下[12]：

  • 吸氣時疼痛加劇
  • 胸部腫脹
  • 胸部瘀青
  • 呼吸短促
  • 咳血（可能是肋骨刺傷肺臟）

照X光可確定位移性骨折，但是往往容易忽略無位移的骨折[13]；以電腦斷層檢查可確定這兩種骨折[13]。 因為兒童的肋骨較成人有彈性，所以較可能彎曲而非直接折斷，因此當兒童患者發生肋骨骨折，代表其遭受劇烈的撞擊，同時也表示患者胸部很可能有重大傷害，如發生肺部挫傷[4]。年長者會發生肋骨骨折，也表示曾遭受較嚴重的外傷[14]。

參見

參考文獻

  1. ^ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Mosby's Medical Dictionary (E-Book). Elsevier Health Sciences. 2013: 1567. ISBN 978-0323112581. （原始内容存档于2017-10-13） （英语）. 
  2. ^ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 May, L; Hillermann, C; Patil, S. Rib fracture management. BJA Education. January 2016, 16 (1): 26–32. doi:10.1093/bjaceaccp/mkv011 可免费查阅. 
  3. ^ 3.0 3.1 3.2 3.3 3.4 Adams, James G. Emergency Medicine E-Book: Clinical Essentials (Expert Consult – Online). Elsevier Health Sciences. 2012: 682. ISBN 978-1455733941. （原始内容存档于2017-10-13） （英语）. 
  4. ^ 4.0 4.1 4.2 Wanek, Sandra; Mayberry, John C. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Critical Care Clinics. 2004, 20 (1): 71–81. PMID 14979330. doi:10.1016/S0749-0704(03)00098-8. 
  5. ^ Nanni, Christina. PET-CT: Rare Findings and Diseases. Springer. 2012: 257. ISBN 978-3-642-24698-2. 
  6. ^ Murphy CE, 4th; Raja, AS; Baumann, BM; Medak, AJ; Langdorf, MI; Nishijima, DK; Hendey, GW; Mower, WR; Rodriguez, RM. Rib Fracture Diagnosis in the Panscan Era. (PDF). Annals of Emergency Medicine. 27 May 2017, 70 (6): 904–909. PMID 28559032. S2CID 23442272. doi:10.1016/j.annemergmed.2017.04.011. 
  7. ^ Brown, SD; Walters, MR. Patients with rib fractures: use of incentive spirometry volumes to guide care.. Journal of Trauma Nursing. 2012, 19 (2): 89–91; quiz 92–03. PMID 22673074. S2CID 45547470. doi:10.1097/JTN.0b013e31825629ee. 
  8. ^ Schuurmans, J; Goslings, JC; Schepers, T. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review.. European Journal of Trauma and Emergency Surgery. April 2017, 43 (2): 163–68. PMC 5378742 可免费查阅. PMID 27572897. doi:10.1007/s00068-016-0721-2. 
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外部連結

分類
編輯維基數據鏈接
外部資源
Scholia上有關肋骨骨折的信息

Template:Fractures Template:Chest trauma

取自“https://zh.wikipedia.org/w/index.php?title=肋骨骨折&oldid=72640368”