胸腔镜下编织牵引技术在肋骨骨折的应用

Weaving and traction technology for fractured ribs in video-assisted thoracoscopic surgery

目的探讨胸腔镜下采用可吸收线穿梭编织捆绑肋骨断端止血固定及肋骨断端牵引技术在肋骨骨折的应用。方法赤峰学院附属医院胸外科2000年6月至2015年4月共收治各类胸外伤肋骨骨折患者865例,仅对89例合并多根多段肋骨骨折连枷胸、大出血、胸内外复合伤的患者采取手术治疗,其中31例实施了电视胸腔镜手术。全组采用可吸收线对骨折肋骨进行捆绑控制肋间血管出血及加强固定,其中25例患者胸腔镜下采用笔者的专利腔镜下肋骨牵开钳进行牵引复位固定,6例患者用可吸收线捆绑肋骨断端后从皮肤引出进行牵引后置入骨钉骨板,均取得较好效果。结果手术时间平均3.1 h,住院时间平均12 d,出血平均720 ml(包括术前出血);全部治愈,无死亡,术后胸壁稳定,自主呼吸排痰良好。随访1个月至3年,胸壁稳定,X线胸片显示固定处均骨痂形成,全组无难以耐受的肋间神经痛。结论编织牵引技术在肋骨骨折的止血、牵引、抬举等方面是一种可行的新技术。

Objectives To discuss prevent bleeding of intercostal vascular and separate open fractures off of the broken end of the rib using the absorption line wear bind fractured ribs end in videoassisted thoracoscopic surgery（ VATS）. Methods Since Jun. 2000 to Apr. 2015,In 865 cases patients with rib fractures,only 31 cases patients with rib fractures have undergone surgical treatment using an intrathoracic implantable fixation technique under C-VATS,the absorption line bundle were used to prevent and control the intercostal vascular hemorrhage at both ends of the rib fracture when the ends are free,under traction,and fixed. 25 cases were treated by the the patent instrument： pulling-open forceps for broken ends of broken ribs to tract and fix during VATS. 6 patients with absorption lines pulling out from the skin for traction after bundling ribs broken end in VATS. Results The average operation time of 3. 1 hours,the12 days of such confinement, the bleeding 720 ml（ including preoperative）, cured without death,postoperative chest wall stability,spontaneous breathing expectoration drainage is good. One month 3 years follow-up,chest wall stability,chest radiograph fixed place both callus formation,the whole group of intercostals neuralgia no difficult to tolerate. Conclusions Knitting technology is a kind of new feasible technology for fractured ribs hemostatic,traction,lifting,etc.