术前超声定位在肋骨骨折微创手术中的应用价值

Clinical value of preoperative ultrasound localization in minimally invasive surgery for rib fracture

目的探讨术前超声定位在肋骨骨折内固定微创手术中的应用价值。方法回顾分析2009年7月至2015年5月收治的43例多发肋骨骨折内固定手术患者的临床资料。根据不同手术切口方式分为超声定位微创切口(研究组)21例,X线、CT体表定位传统剖胸切口(对照组)22例。比较两组术前体表定位准确率、皮肤切口长度、手术当日及术后第1日胸腔引流量、术后胸腔引流管留置时间、呼吸机支持率、肺不张发生率的差异。结果与对照组相比,研究组术前体表定位准确率高(100.00%vs 84.11%,P<0.01),皮肤切口长度小[(2.70±1.35)cm vs(5.17±2.52)cm,P<0.01],术后当日胸腔引流量少[(22.95±21.51)ml/h vs(38.74±24.98)ml/h,P<0.05],胸腔引流管留置时间短[(4.90±2.49)d vs(7.00±3.64)d,P<0.05],肺不张发生率低(14.29%vs 45.45%,P<0.05);而术后第1天胸腔积液引流量和呼吸机支持率比较两组差异均无统计学意义(P均>0.05)。结论术前超声定位微创切口肋骨骨折内固定手术具有定位精确、创伤小、术后当日胸腔引流量少、术后胸管拔除早、术后肺不张发生率低的优点,在胸腔镜的配合下不漏检胸内损伤。

Objective To study the applied value of preoperative ultrasound localization in minimally invasive operation for internal fixation of rib fractures. Methods A retrospective analysis of 43 cases of multiple rib fractures treated by internal fixation surgery from July 2009 to May 2015 was made. According to the surgical incision mode,the patients were designed as two groups： research group（ n = 21） treated with minimally invasive internal fixation by preoperative ultrasonic localization and control group（ n = 22） treated with traditional thoracotomy incision by locating of chest X-rays and CT. The accuracy of preoperative positioning,chest skin incision length,the amount of thoracic cavity drainage on the operation day and the first postoperative day,postoperative chest tube indwelling time,ventilator support rate and the incidence of atelectasis were compared between two groups. Results Compared with the control group,the research group had higher accuracy rate of preoperative positioning of body surface [100%（ 94 /94） vs 84. 11%（ 90 /107）,P 0. 01],shorter length of skin incision [（ 2. 70 ± 1. 35） cm vs（ 5. 17 ± 2. 52） cm,P 0. 01],less amount of thoracic cavity drainage on the operation day[（ 22. 95 ± 21. 51） ml/h vs（ 38. 74 ± 24. 98） ml/h,P 0. 05],shorter postoperative indwelling time of thoracic drainage tube [（ 4. 90 ± 2. 49） d vs（ 7. 00 ± 3. 64） d,P 0. 05]and lower incidence of postoperative atelectasis [14. 29%（ 3 /21） vs45. 45%（ 10 /22）,P 0. 05]. There were no statistical differences in the amount of thoracic cavity drainage [（ 10. 06 ±9. 37） ml / h vs（ 13. 39 ± 10. 79） ml / h]and ventilator support rate[19. 05%（ 4 /21） vs 36. 36%（ 8 /22） ]on the first day after surgery between two groups（ all P 0. 05）. Conclusions Preoperative ultrasound localization for minimally invasive internal fixation surgery of rib fracture has the advantages of precise preoperative positioning,light operative trauma,less amount of thoracic cavity drainage on the operation day,the shorter postoperative indwelling time of thoracic drainage tube,lower incidence of postoperative atelectasis and can avoid the undetected intrathoracic injuries with the coordination of thoracoscope.