早期肋骨内固定术治疗创伤性连枷胸合并肺挫伤的临床效果观察

Clinical observation of early rib internal fixation for treatment of traumatic flail chest combined with pulmonary contusion

目的观察创伤性连枷胸合并肺挫伤行早期开胸探查、肋骨内固定术的临床效果。方法将2009年1月~2012年12月采用早期开胸探查、肋骨内固定术治疗的46例创伤性连枷胸合并肺挫伤患者设为治疗组，同期保守治疗的40例患者设为对照组，比较两组患者的疗效及并发症情况。结果治疗组ICU入住时间、呼吸机支持时间、肺不张、胸廓畸形、死亡率等均明显低于对照组（P〈0．05），出院行肺功能检查各参数明显优于对照组（P〈0．05）。结论早期行开胸探查、肋骨内固定术治疗创伤性连枷胸合并肺挫伤可以早期评估胸内脏器损伤情况并行相应处理，能及时消除胸壁软化及反常呼吸运动，改善呼吸功能，减少并发症，改善预后。

Objective To observe the clinical effect of early rib internal fixation for the treatment of traumatic flail chest combined with pulmonary contusion. Methods The medical records of patients with flail chest combined with pul- monary contusion were analyzed retrospectively, including 46 cases underwent thoracotomy and ribs internal fixation and 40 cases non operation treatment. The effect and complications were compared between the two groups. Results In the treatment group, the time of therapy in ICU, ventilator support time, atelectasis, thoracic deformity, mortality were sig- nificantly lower than that in the control group （P〈0.05）. The pulmonary function test was better than that of non oper- ation group. Conclusion Early thoracotomy and rib fixation for treatment of traumatic flail chest and pulmonary contu- sion can early assess thoracic viscera injury , timely eliminate chest wall malacia and paradoxical respiratory movement, improve respiratory function and decrease the complications.