损伤控制性肋骨接骨板手术在创伤性连枷胸中的应用价值

Values of embracing fixator for damage-control surgery in the management of traumatic flail chest

目的探讨损伤控制性手术在创伤性连枷胸中的应用价值。方法收集2015年5月—2016年4月收集余姚市人民医院创伤性连枷胸患者60例,采用随机数字表法,将患者分为实验组(30例)和对照组(30例),其中实验组采用损伤控制性肋骨接骨板治疗,对照组采用肋骨固定带固定。主要观察指标为临床干预指标、主要并发症和临床预后。结果与对照组比较,实验组患者镇痛药物使用时间显著缩短[(2.41±1.43)d vs.(4.21±2.61)d,P=0.012];抗生素使用时间显著缩短[(3.24±2.93)d vs.(6.32±2.43)d,P=0.008];术后机械通气时间明显缩短[(2.82±0.79)d vs.(5.21±1.33)d,P=0.028];肺不张发生率显著减少(3.33%vs.23.33%,P=0.023);住院时间显著缩短[(18.32±7.43)d vs.(26.43±11.93)d,P=0.002]。2组患者机械通气率、胸腔闭式引流率、胸腔闭式引流时间、肺部感染率和急性呼吸窘迫综合症等差异无统计学意义(P>0.05)。研究期间,无患者死亡。结论损伤控制性肋骨接骨板手术显著改善创伤性连枷胸患者临床预后并缩短了患者的整体住院时间。

Objective To investigate the values of embracing fixator for damage-control surgery in the management of traumatic flail chest. Methods Sixty patients with traumatic flail chest were enrolled in this prospectively study. According to the principle of completely random digital table, all patients were randomly signed into experiment group （n = 30 ） or control group（ n = 30）. Damage control surgery with embracing fixator was adopted in experiment group, while fixed rib fixation was adopted in the control group. The primary outcomes were clinical interventions, major complications and clinical outcomes. Results When compared with the control group, patients in the experiment group got a significantly shorter analgesic drug use time [ （ 2.41 ± 1.43 ） d vs. （ 4.21 ± 2.61 ） d, P = 0.012 ] ; a significantly shorter antibiotic use duration[ （3.24 ± 2.93 ） d vs. （6.32 ± 2.43 ） d, P = 0. 008 ）] ;a significantly shorter mechanical ventilation duration [ （2.82 ± 0.79） d vs. （5.21 ± 1.33 ） d, P = 0. 028 ] ; a significantly lower rate of pulmonary atelectasis （3.33% vs. 23.33% ,P = 0. 023 ） ;and a significantly shorter hospital duration [ （ 18.32 ± 7.43 ） d vs. （ 26.43 ± 11.93 ） d, P = 0. 002 ]. There was no difference between the two groups in mechanical ventilation, closed drainage of thoracic cavity, closed drainage of thoracic cavity duration, lung infection and acute respiratory distress syndrome （P 〉 0.05 ）. None patients died during the study period. Conclusion The embracing fixator for damage control surgery in the management of traumatic flail chest improves the clinical outcomes and hospital duration.