四种固定材料在肋骨骨折内固定中的临床应用及比较

Clinical application and comparison of four different materials on rib fracture internal fixation

目的比较钢丝、可吸收髓内钉、记忆合金环抱器、条形钢板四种肋骨内固定材料在肋骨骨折内固定中的差异。方法近4年来我科共实施肋骨骨折内固定术83例,其中钢丝固定者11例,可吸收髓内钉固定者34例,记忆合金环抱器固定者25例,条形钢板固定者13例。比较四种固定方式在手术费用,手术时间,胸廓畸形矫正程度,断端复位情况,牢固程度及疼痛程度方面的差异。结果钢丝肋骨固定术操作简单,手术时间短,手术费用低廉,断端复位情况及牢固程度较差,且不可吸收。可吸收髓内钉肋骨固定手术费用较高,断端复位情况及牢固程度较差,但可吸收。记忆合金环抱器操作复杂,手术时间长,费用较高,断端复位情况及牢固程度好。条形钢板手术操作简单,断端复位情况及牢固程度可,术后无肋间神经卡痛现象,但不可吸收,放射线下表现明显。结论四种材料的肋骨固定各有其优缺点,临床上应结合固定材料的特点,病情以及患者经济能力综合考虑应用。

Objective To compare the clinical application efficacy of four internal fixation ma- terials （steel wire, absorbable intramedullary nail, memory embracing fixator, and steel plate） on rib fracture. Methods A total of 83 rib fracture patients were included in this study. Of them, 11 cases were performed internal fixed with steel wire material, 34 patients with absorbable intramedullary nail, 25 patients with memory alloy embracing fixator, and 13 patients with steel plate. The cost, operation time, complications and pain were compared among the four groups. Results The patients in steel wire group was characterized of a simple operation, lower cost, but poor broken end reduction and firmness, and a non-absorbable material. Absorbable intramedullary nail group showed a higher cost, poor restora- tion of broken ends and fastness, but completely absorbable material. Memory embracing fixator group had vantage to better restoration of broken ends and fastness degree with complex operation and higher cost The last steel plate group was easy to use, and had a good restoration of broken ends and fastness degree, but non-absorbable material and X-rays exposure. Conclusion Each own relative merits was found in four different internal fixation materials on rib fracture. We should select appropriate material according to material character, special situation of rib fracture, and hospitalization cost.