肋骨内固定最佳手术时机的探讨

A study on the optimal surgical timing for rib internal fixation

目的探讨肋骨骨折内固定的最佳手术时机。方法回顾性分析143例肋骨骨折患者的临床资料，根据受伤至手术内固定时间是否超过72h分为早期固定组62例和晚期固定组81例，记录并比较两组失血量与体表面积比、肺部并发症情况及术前、术后第5天C反应蛋白水平变化。结果两组患者均痊愈出院。晚期固定组术前C反应蛋白中位数为45mg／L，早期固定组为23mg／L，差异有统计学意义（P〈0．01）。早期固定组失血量与体表面积比为（334．19±37．53）ml／m2，肺部并发症发生率为22．6％（14／61），晚期固定组分别为（438．99±55．24）ml／m2，38．3％（31／81），差异有统计学意义（P〈0．01或〈0．05）。早期固定组术后第5天C反应蛋白中位数为189mg／L，晚期固定组为258mg／L，差异有统计学意义（P〈0．01）。结论在创伤后早期（72h内）行肋骨内固定，有望减轻患者创伤后的全身反应，减少出血以及创伤并发症的发生。

Objective To investigate the optimal surgical timing for rib internal fixation. Methods The clinical data of 143 patients with rib fracture were retrospectively analyzed. The patients were divided into early phase fixation group （62 cases） and late phase fixation group （81 cases） according to the time from trauma to internal fixation. The ratio blood lose and body surface area,pulmonary complications and the changes of C reactive protein level before and 5 days after operation were recorded and compared. Results All the patients were healing. The median C reactive protein before operation in late phase fixation group was 45 mg/L,in early phase fixation group was 23 mg/L,there was statistical difference （P 〈 0.01 ）. The ratio blood lose and body surface area in early phase fixation group was （334.19 ±37.53） ml/m2,the rate of pulmonary complications was 22.6%（ 14/61 ） ,in late phase fixation group was （438.99 ±55.24） ml/m2 and 38.3%（31/81 ）, there were statistical differences （P 〈 0.01 or 〈 0.05 ）. The median C reactive protein 5 days after operation in early phase fixation group was 189 mg/L,in late phase fixation group was 258 mg/L,there was statistical difference （P 〈 0.05 ）. Conclusion Early phase （72 hours ） rib internal fixation is expected to reduce patient trauma of systemic reactions, reduce the incidence of bleeding and pulmonary complications.