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Master Thesis

Comparaison de deux stratégies de prise en charge des volets thoraciques en région Rhône-Alpes : ostéosynthèse costale ou traitement médical standard ?

Abstract : Flail chest injury, wich is the most serious parietal thoracic damage after trauma, can lead to a high rate of mortality, early but also delayed due to secondary complications. The treatment of flail chest is based on mechanical ventilation and the place of the surgical stabilization is not clearly established, but recent studies suggest some benefits with surgical treatment. We compared two strategies of management of flail chest: the surgical stabilization in Lyon and Annecy, and the standard medical management in Grenoble. This trial is based on data from two registers of trauma from Rhône-Alpes region, between 2010 and 2015. The included patients were adults and suffered from a flail chest, with or without any other injuries, except a serious head trauma. The primary endpoint was the lenght of mechanical ventilation. Fifty three patients were included in the surgical stabilization group and 45 patients in the standard medical management group, these two groups were comparable in clinical data. There was a trend to a lowered lenght of mechanical ventilation with the surgical stabilization (3,9 days vs 6.3 days, p=0.166). When only isolated thoracic traumas were considered, 26 were in the surgical stabilization group and 27 patients were in the standard medical management group, the lowered lenght of mechanical ventilation became statistically significant (1,7 day versus 6,7 days, p=0,0496). The complications were rare, and without detriment to the outcome of patients. In conclusion, surgical stabilization in selected patiens reduce the lenght of mechanical ventilation with a low morbidity.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01148005
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Submitted on : Monday, May 4, 2015 - 9:25:56 AM
Last modification on : Tuesday, May 11, 2021 - 11:36:18 AM

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  • HAL Id : dumas-01148005, version 1

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Caroline Sergent. Comparaison de deux stratégies de prise en charge des volets thoraciques en région Rhône-Alpes : ostéosynthèse costale ou traitement médical standard ?. Médecine humaine et pathologie. 2015. ⟨dumas-01148005⟩

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