肋骨内外固定治疗连枷胸合并肺挫伤的临床价值

The clinical effect of the internal and external fixation for treating flail chest associated with pulmonary contusion

目的评价肋骨内、外固定术在治疗连枷胸合并肺挫伤的临床价值。方法对80例连枷胸合并肺挫伤患者,采用肋骨内固定治疗组(A组)40例,传统外固定治疗组(B组)40例。除骨折固定方法不同外,其余治疗相同。结果胸壁固定后PaO2明显升高(P<0.01),肋骨内、外固定两组比较,带机时间(5±2)天VS(11±3)天,住ICU时间(5.6±1.2)天VS(11.4±1.8)天,肋骨内固定组明显缩短(P<0.01);肺不张4/40例VS 7/40例,肺部感染3/40例VS 5/40例,ARDS 3/40例VS 6/40例,死亡率2/40例VS 4/40例,组间差异无统计学意义(均P>0.05)。术后3～6个月随访查胸部X线片,内固定组肋骨骨折愈合好,无胸廓畸形,外固定组28/40例存在程度不同畸形,两组肺功能测定[FVC(3.42±0.52)VS(2.74±0.33),FEV1(2.93±0.34)VS(2.02±0.26),均P<0.05]。内固定组优于外固定组。结论肋骨内固定术比外固定在治疗连枷合并肺挫伤中效果更好,更确切。不赞成连枷胸时呼吸机作"气体正压内固定",强调呼吸机治疗是因肺挫伤,而非连枷胸。

Objective To evaluate the clinical value of the external and internal fixation in the treatment of flail chest with pulmonary contusion. Methods We made a retrospective analysis of 80 cases of flail chest with pulmonary contusion admitted to our hospital from Jan. 2004 to Jan. 2012. All cases were divided into internal fixation group （group A） with 40 cases and traditional external fixation group （group B） with 40 cases too. The treatment was the same in ad- dition to the methods of fracture fixation. Results PaOz was significantly higher （P〈0.01） after chest wall fixed. The mechanical ventilation time of group A and group B were compared to be 55=2 days VS 115=3 days, while the duration of ICU stay to he 5.6±1.2 days VS 11.45=1.8 days, which showed a significantly shorten in group A （P〈0. 01）. There were 4/40 vs. 7/40 cases of atelectasis, 3/40 vs. 5/40 cases of pulmonary infections, 3/40 vs. 6/40 cases of ARDS, and 2/40 VS 4/40 cases of mortality, but these were not statistically significant （P〉0.05）. Chest X-ray follew up after 3-6 months, rib fracture in group A was healed with no thoracic deformity, group B partly existed different levels of deformi- ty （28/40）, Lung function was measured and compared between group A and group B： FVC 3.42±0. 52 VS 2. 74± 0. 33, FEV1.0 2.93±0. 34 VS 2.02±0. 26 （P〈0.05）. Group A was superior to group B. Conclusion Internal fixation is more effective than external fixation for flail chest with pulmonary contusion. Mechanical ventilation was not suggested to be used as internal pneumatic stabilization with positive pressure.