内固定术联合胸腔镜治疗肋骨骨折

Thoracoscope-assisted internal fixation for treatment of rib fracture

目的探讨内固定术联合应用胸腔镜治疗肋骨骨折的疗效。方法选择2010年7月-2013年6月收治的180例肋骨骨折伴胸廓畸形患者，根据治疗方法不同分为内固定术联合胸腔镜组（手术组，90例）和非手术治疗组（非手术组，90例）。观察两组疼痛持续时间、呼吸机使用时间、住院时间、并发症等临床指标；通过自尊量表评分（SES）评价两组患者心理健康状况；并比较两组患者活动能力受限情况。结果手术组疼痛持续时间为（3．1±1．0）d，呼吸机使用时间为（3．0±1．0）d，住院时间为（10．0±1．1）d，非手术组分别为（8．9±1．2）d、（4．8±1．0）d、（15．8±1．0）d（P均〈0．01）。手术组、非手术组SES分别为（28．3±2．1）分、（24．4±3．3）分（P〈0．01）。手术组未见明显并发症，2例术后活动能力受限。非手术组41例出现严重并发症（20例胸腔积液，15例严重胸廓塌陷、畸形，14例肺部感染，10例顽固性胸痛，2例上肢功能受伤），12例出现活动明显受限。两组在并发症发生率及活动能力受限方面差异均有统计学意义（P〈0．01）。结论内固定联合胸腔镜治疗肋骨骨折能够加快康复速度，减轻疼痛及降低并发症发生率，是可优先选择的手术模式。

Objective To discuss the clinical efficacy of internal fixation assisted by thoraeoscope in treatment of rib fractures. Methods The study enrolled 180 patients with rib fractures associated with thoracic deformity hospitalized from July 2010 to June 2013. Ninety out of the patients were operated on by thoracoscope-assisted internal fixation （operation group） , and the remaining 90 fractures were treated non-operatively （non-operation group ）. Clinical markers recorded were duration of pain, time of ventilator use, hospital length of stay and complications. Patient mental health was measured with self esteem scale （SES）. Patient mobility was evaluated at follow-up. Results Between operation and non-operation groups differences were observed in duration of pain [ （3.1 ±1.0）d vs （8.9 ± 1.2） d], time of ventilator use [ （3.0 ±1. 0） d vs （4.8 ±1.0） d] and hospital length of stay [ （ 10.0 ±1.1）dvs （15.8±1.0）d] （P〈0.01）. SES in operation group was （28.3±2.1） versus （24.4±3.3） points in non-operation group （P 〈 0.01 ）. No major complications occurred in operation group, but there were 20 pleural effusion, 15 severe thoracic collapse or deformity, 14 lung infection, 10 refractory chest pain and 2 upper limb dysfunction in non-operation group （P 〈0.01 ）. Two patients presented mobility limitation in operation group, but 12 had evident loss of mobility in non-operation group （P 〈 0.01 ）. Conclusions Thoracoscope-assisted internal fixation is effective to accelerate the pace of recovery, relieve pains, reduce complications and thus can be a priority method for treatment of rib fractures.