连枷胸伴肺挫伤的腔镜手术固定与非手术固定的临床研究

Clinical research on surgical and non surgical fixation of flail chest with multiple injuries

目的比较连枷胸伴肺挫伤的腔镜手术固定与非手术固定的疗效。方法对66例以连枷胸伴肺挫伤为主的全身多发伤患者的临床资料进行回顾性分析,比较腔镜手术内固定治疗组(n=35)与非手术外固定治疗组(n=31)的临床疗效。结果治疗效果指标:平均住院时间、平均住ICU时间、平均机械通气时间及疼痛评分(vas),腔镜手术组低于非手术组(P<0.05),并发症指标如胸壁畸形、肺部炎症、肺不张和呼吸功能衰竭等发生率腔镜手术组患者显著低于非手术组(P<0.05)。出院后3个月,手术组患者肺功能指标包括肺活量、残气量、肺总量、最大自主通气量均显著高于非手术组(P<0.05)。结论腔镜手术内固定治疗连枷胸伴肺损伤疗效明显优于非手术治疗。

Objective To compare the outcomes of traumatic flail chest with muhip]e injuries treated by operative fixation versus conservative approach. Methods The clinical data of 66 patients with traumatic flail chest with multiple injuries were retrospectively analysed, and the outcomes between operation group （treated by operative fixation, n = 35and non-operation group treated by conservative approach, n = 31） were compared. Results The mean time of hospital stay, ICU stay and mechanical ventilation was significantly shorter, and the prevalences of chest wall deformity, pulmonary infection, pulmonary ateleetasis and respiratory failure were significantly lower in operation group than those in non- operation group （P 〈 0.05）. Three months after discharge, the pulmonary function parameters such as inspiratory capacity, forced vital capacity, forced expiratory volume in one second, peak expiratory flow, total lung capacity and maximal midexpiratory flow were significantly higher in operation group than those in non-operation group （P 〈 0.05）. Conclusion Traumatic flail chest with multiple injuries treated by operative fixation may lead to less flail chest associated complications. Operative fixation has short- and long-term benefits to flail chest.