肋骨内固定术治疗创伤性连枷胸

Rib internal fixation for traumatic flail chest

目的 比较肋骨内固定术和外固定胸廓治疗创伤性连枷胸的临床疗效.方法 回顾性分析2006年1月至2009年6月收治的86例以创伤性连枷胸为主的多发伤病例的临床资料,分为内固定组和外固定组.内固定组45例,采用镍钛记忆合金环抱式接骨器内固定肋骨骨折;外固定组41例,采用外固定胸廓非手术保守治疗.比较2组的临床疗效.结果 内固定组患者胸壁畸形均消失,而外固定组中有19例患者遗留胸壁畸形.内固定组患者平均住院时间、平均住ICU时间和平均机械通气时间均短于外固定组[（15.1±1.8）d与（22.9±2.8）d,t=-15.724;（5.7±1.5）d与（14.4±2.9）d,t=-17.711;（3.9±1.5）d与（11.6 ±2.3）d,t=-17.256;P均＜0.01],内固定组患者呼吸系统并发症[包括肺部炎症或（和）肺不张或（和）呼吸功能衰竭]的发生率低于外固定组（35.6%与70.7%,Х^2=10.641,P＜0.01）.出院3个月后,内固定组患者肺功能指标包括肺总量、用力肺活量、1秒钟用力呼气容积、呼气峰流量、75%肺活量最大呼气流量均高于外固定组[（89.5±3.1）%与（79.1±5.1）%,t=11.705;（80.2±2.8）%与（69.8±3.8）%,t=14.241;（74.8±4.4）%与（71.9±3.6）%,t=3.201;（82.8±4.4）%与（79.8±4.9）%,t=2.885;（68.2±2.2）%与（61.9±2.9）%,t=11.286;P均＜0.01].结论 肋骨内固定手术治疗创伤性连枷胸,可以迅速纠正畸形,稳定胸廓,消除反常呼吸,治疗过程顺利,缩短重症监护及住院时间,减少并发症,还可以减轻连枷胸对患者远期肺功能的影响.采用镍钛记忆合金环抱式接骨器内固定肋骨,手术简单、方便,疗效确切.

Objective To compare the effects of rib internal fixation and thoracic external fixation in treatment of traumatic flail chest. Methods Eighty six cases of traumatic flail chest with multiple injuries,admitted to hospital from January 2006 to June 2009 ,were recruited into the study and divided into rib internal fixation and thoracic external fixation groups randomly. The clinical data were analyzed retrospectively. Rib internal fixations with Ti-Ni shape memory alloy embracing connector were performed in internal-fixation group（n = 45） and thoracic external fixations were performed in external-fixation group（n = 41）. The outcomes were compared between the two groups. Results No patient in internal-fixation group developed chest wall deformity,while 19 patients in external-fixation group had chest wall deformity left. The mean times of hospital stay（[ 15. 1 ± 1.8]d vs [22. 9 ±2. 8]d,t = - 15. 724,P 〈0. 01） ,ICU stay（[5.7 ± 1.5]d vs [ 14. 4 ±2. 9]d,t =- 17.711, P 〈 0. 01）, and mechanical ventilation（[ 3.9 ± 1.5 ] d vs [ 1 1.6 ± 2. 3 ] d, t = - 17. 256, P 〈 0. 01）,in internal-fixation group were significantly shorter than those in external-fixation group. The occurrence rate of respiratory complications （including pulmonary inflammation and （or） atelectasis and （or） respiratory failure）in internal-fixation group was significantly lower than those in external-fixation group（35.6% vs. 70. 7% ,Х^2 =10.641,P 〈 0.01）. Followed-up data of three months after discharge showed that the pulmonary function parameters, such as total lung capacity（[ 89. 5 ± 3. 1 ] % vs. [ 79. 1 ± 5. 1 ] %, t = 11. 705, P 〈 0. 01）, forced vital capacity（[ 80. 2 ± 2. 8 ] % vs. [ 69. 8 ± 3. 8 ] % ,t = 14. 241 ,P 〈0. 01） ,forced expiratory volume in the 1st second （[74.8 ±4.4]% vs. [71.9 ±3.6]% ,t =3.201,P 〈0.01）,peak expiratory flow （[82.8 ±4.4]%vs. [79. 8 ±4. 9]% ,t =2. 885,P 〈0. 01） and forced expiratory flows at 75% of the vital capacity（ [68.2 ±2. 2] % vs. [61.9 ± 2. 9 ]%, t = 11. 286; P 〈 0. 01） were significantly higher in internal-fixation group than those in external-fixation group. Conclusion Rib internal fixation for traumatic flail chest can quickly correct chest wall deformity, stabilize thoracis and eliminate paradoxical chest wall movement. Patients accepted this treatment have a shorter therapy process during the intensive care unit and hospital stay, less pulmonary complications. They also show less long-term restrictive pulmonary functions impairment, when compared to the patients in the thoracic external fixation group. Rib internal fixation with Ti-Ni shape memory alloy embracing connector is a simple and effective therapy.