肋骨内固定联合电视胸腔镜治疗重症连枷胸

Fixed operation of multiple rib fractures and video-assisted thoracoscope treatment for severe flail chest

目的探讨重症连枷胸早期应用钛合金接骨板内固定联合电视胸腔镜手术治疗的临床经验及诊治效果。方法 2010年7月—2014年6月需行肋骨内固定的重症连枷胸外伤患者160例,随机分为两组:对照组79例应用行常规胸腔闭式引流加肋骨骨折内固定术;观察组81例行电视胸腔镜开胸探查肋骨骨折内固定术。比较两组术后肺功能、血氧饱和度、胸腔引流量、肺复张程度、住院时间等指标。结果本组160例患者中死亡3例,均为对照组患者;观察组平均胸腔引流时间2.5 d,对照组为5.5 d,两组差异有统计学意义(P<0.05)。观察组术后血氧饱和度、肺功能、并发症发生率、住院时间、疼痛评分、病死率等均优于对照组,差异有统计学意义(P<0.05)。结论电视胸腔镜开胸探查同期行肋骨骨折内固定手术,可有效改善肺功能、纠正呼吸衰竭、控制胸壁反常呼吸、降低疼痛评分、减少连枷胸患者并发症和病死率,有利于患者病情恢复,改善生活质量。

Objective To summarize and analyze surgical treatment experience and clinical application value for severe flail chest, the treatment method is to combine surgically fix titanium plate with video - assisted thoracoscope surgery. Methods Adopted 160 severe flail chest cases require fixed operation from July,2010 to June,2014. The patients were arranged as two groups according to the doctor＇ s requirements by our fulltime nurses. 79 cases normal closed thoracic drainage and internal fixation of rib fracture were recorded as control group; 81 cases of video - assisted thoracoscope surgery with ribs internally fixed treatment were recorded as observation group. Then compare the results of postoperative lung function, oxygen concentration, chest drainage volume, pulmonary atelectasis, length of stay and other after operations. Results The treatment results include oxygen concentration, lung function, the complication rate, length of stay, pain score and death rate. The results of observation group are better than that of the control group on average. Conclusion Apply on internal plate fixing operation to ribs during video - assisted thoracoscope surgery will effectively improve lung function, prevent respiratory failure, control thoracic paradoxical respiration and reduce pain score, reduce the complication and death rate of flail chest, be helpful for rapid recovery and improve quality of life.