胸壁负压引流对肋骨骨折内固定术后康复的影响

Effect of chest wall negative pressure drainage on postoperative rehabilitation of rib fracture patients after internal fixation

目的:探讨胸壁负压引流对肋骨骨折内固定术患者术后康复的影响。方法:回顾分析2009年7月—2014年12月收住入院的多发肋骨骨折内固定手术患者266例。根据处理方式将其分为对照组和试验组。对照组(n=65)采用常规手术康复治疗与护理;试验组(n=201)在对照组基础上行胸壁负压引流。比较两组术后皮下积液患者比例、切口拆线时间、切口感染患者比例、住院天数、生活质量评分等。结果:试验组术后皮下积液和切口感染患者比例均显著低于对照组[(1.49%,3/201)vs(30.77%,20/65),(0,0/201)vs(4.62%,3/65),P<0.05];试验组切口拆线时间及住院天数短于对照组[(9.1±1.2)d vs(14.2±1.3)d,(10.2±0.9)d vs(16.3±1.1)d,P<0.05];试验组生活质量评分显著高于对照组(P<0.05)。结论:胸壁负压引流可促进肋骨骨折内固定术后皮下积液的排出、降低切口感染率,从而缩短切口愈合时间和住院时间,降低住院费用。建议在肋骨骨折内固定术中,尤其是在肋骨骨折多、胸部损伤重、并发症多的肋骨骨折内固定术中,予以胸壁负压引流。

Objective：To investigate the effect of chest wall negative pressure drainage on postoperative rehabilitation of rib fracture patients after internal fixation .Methods：266 cases of patients with multiple rib fractures hospitalized from July 2009 to December 2014 were retrospectively analyzed .They were randomly divided into the control group （n=65） ,which was given conventional surgical rehabilitation treatment and nursing ,and the experimental group （n=201） ,which was given chest wall negative pressure drainage apart from what was given to the control group .Indices such as subcutaneous effusion ,incision suture removal time ,incision infection ,length of hospital stay and life quality scores were compared between the two groups . Results：The number of subcutaneous effusion and the number of incision infection in the experimental group were significantly lower than those in the control group （1 .49 % vs 30 .77 % ,0 .00% vs 4 .62 % ;P〈0 .05） .The incision suture removal time and the length of hospital stay in the experimental group were significantly shorter than those in the control group （[9 .1 ± 1 .2] d vs [14 .2 ± 1 .3]d ,[10 .2 ± 0 .9] d vs [16 .3 ± 1 .1]d;P〈0 .05） .The life quality scores in the experimental group were significantly higher than those in the control group （P〈0 .05） .Conclusions：Chest wall negative pressure drainage can promote the discharge of subcutaneous effusion and reduce incision infection rate so as to shorten the wound healing time and length of hospital stay ,and also reduce the cost of hospitalization .So it is recommended that negative pressure drainage should be placed on the chest wall in rib fracture internal fixation , especially in multiple rib fracture , serious chest injury and more complications .