胸腔镜辅助可吸收肋骨钉与爪形接骨板联合应用治疗多发肋骨骨折的临床研究

Clinical study of absorbable screw and claw-like rib bone plate fixation aided by video-assisted thoracoscope for multiple rib fracture

目的探讨胸腔镜辅助可吸收肋骨钉与纯钛爪形接骨板联合应用治疗多发肋骨骨折的临床疗效及优点。方法选取我院2008年3月-2013年3月共收治的87例多发肋骨骨折患者的临床资料，其中49例采用胸腔镜辅助（VATS组）可吸收肋骨钉与纯钛爪形接骨板联合内固定术，其余38例采用传统开胸（对照组）纯钛爪形肋骨接骨板内固定术，比较两组患者临床治疗效果及并发症等情况。结果87例均痊愈出院，VATS组患者手术切口利用率、手术时间、术中出血量、机械通气时间、胸管留置时间、ICU监护时间、住院时间、疗效评价及呼吸功能改善情况均优于对照组（P〈0．05）。VATS组术后迟发性血气胸、肺部感染、切口血肿、胸廓畸形、骨折移位及顽固性胸痛等并发症的总发生率为10．20％（5／49），对照组为18．42％（7／38），VATS组并发症总发生率低于对照组，差异有统计学意义（P〈0．05）。结论胸腔镜辅助可吸收肋骨钉与纯钛爪形肋骨接骨板联合应用技术治疗多发肋骨骨折疗效优于传统开胸纯钛爪形肋骨接骨板内固定术式，值得推广。

Objective To study the clinical effect and advantages of absorbable screw and titanium clawlike rib bone plate fixation aided by video-assisted thoracoscope in treating multiple rib fracture. Methods The clinical data of 83 cases of multiple rib fracture were analyzed, who were admitted into our hospital from Mar. 2008 to Mar. 2013. Among them,49 cases underwent internal fixation aided by video-assisted thoracoscope with absorbable screw and titanium claw-like rib bone plate{ VATS group） ,and the other 38 cases underwent internal fixation with ti- tanium claw-like rib bone plate { control group }. Outcomes and complications were assessed and compared between the two groups. Results All 87 patients were cured. The use of absorbable screw and titanium claw-like rib bone plate fixation aided by video-assisted thoracoscope was better than that of the traditional treatment for multiple rib fracture { P 〈 0.05 } on the utilization rate of incision, operation time, peri-operative bleeding, mechanical ventilation time, detaining time of thoracic drainage tube, ICU monitoring time, hospitalization time, curative effect and respirato- ry function improvement. The total rates of complications occurrence such as late - occurred hemopneumothorax, pulmonary infection, incision hematoma, thoracocyllosis, displacement fracture, intractable pain in VATS group [ 10. 20% （ 5/49 } ] were lower than those in control group [ 18.42% （ 7/38 ） ], indicating a statistically significant difference （ P 〈 0.05 ）. Conclusion The effect of internal fixation aided by video-assisted thoracoseope with ab- sorbable screw and titanium claw-like rib bone plate in treating multiple rib fracture is superior to the traditional treatment with titanium claw-like rib bone plate, so it is worthy promoting in clinical practice.