胸腔镜辅助镍钛记忆合金肋骨接骨板内固定术治疗多发肋骨骨折临床疗效研究

Clinical effect of thoracoscopy assisted internal fixation of NiTi memory alloy rib bone plate in the treatment of multiple rib fractures

目的探讨多发肋骨骨折治疗中使用胸腔镜辅助技术的临床效果及优点。方法 2014年5月—2017年5月无锡市人民医院胸心外科收治多发性肋骨骨折患者78例,采用胸腔镜辅助镍钛记忆合金肋骨接骨板内固定术治疗41例(胸腔镜组),采用传统行开胸手术及肋骨内固定术治疗37例(传统组),分析比较两组患者的24h血气分析参数、VAS评分、两组患者治疗相关指标、肺通气功能及术后并发症。结果 24h血气分析参数比较:与传统组比较,胸腔镜组治疗前后PaCO_2、PaO_2均差异大,差异有统计学意义(P <0. 05);传统组治疗前后PaCO_2差异无统计学意义(P>0. 05),PaO_2则差异有统计学意义(P <0. 05)。组间比较:传统组PaCO_2显著高于胸腔镜组(P <0. 05),PaO_2显著低于胸腔镜组(P <0. 05)。VAS评分比较:胸腔镜组术后第1、4、7天的VAS均低于传统组,差异有统计学意义(P <0. 05)。肺通气功能比较:两组治疗后第1天肺功能无明显差异(P> 0. 05);胸腔镜组治疗后第7天最大通气量(MVV)显著优于传统组(P <0. 05),另外三项差异不明显(P>0. 05);胸腔镜组治疗后第30天四项肺功能指标均优于传统组(P <0. 01)。治疗相关指标比较:住院时间、胸管留置时间、手术时间、术中出血量、自主下床活动时间、胸管引流量方面比较,胸腔镜组均优于传统组(P <0. 05)。术后并发症比较:胸腔镜组包裹性胸腔积液、肺不张、肺部感染并发症发生率均明显低于传统组(P <0. 05)。结论多发肋骨骨折患者使用胸腔镜辅助下镍钛记忆合金肋骨接骨板固定术治疗,在改善手术相关指标和预后以及降低术后并发症等方面均具有积极作用,值得临床推广。

Objective To investigate the clinical effects and advantages of video-assisted thoracoscopic surgery in the treatment of multiple rib fractures. Methods Seventy-eight patients with multiple rib fractures admitted to the Department of Thoracic and Cardiac Surgery of Wuxi People s Hospital from May 2014 to May 2017 were selected. Thoracoscopic assisted internal fixation with nickel titanium memory alloy rib plate was performed in 41 patients （thoracoscopic group）. Thoracotomy and rib internal fixation were performed in 37 cases（traditional group）. The 24 hour blood gas analysis parameters and visual analogue scale （VAS） were analyzed and compared between the two groups. The treatment related indexes,pulmonary ventilation function and postoperative complications were compared between the two groups. Results Before and after treatment, there were significant differences in PaCO 2 and PaO 2 between the thoracoscopic group and the traditional group（ P 〈0.05）.Before and after treatment, there was no significant difference in PaCO 2 in the traditional group（ P 〉0.05）.There was a significant difference in PaO 2 in the traditional group before and after treatment（ P 〉0.05）.The PaCO 2 in the traditional group was significantly higher than that in the thoracoscopic group（ P 〈0.05）. The PaO 2 in the traditional group was significantly lower than that in the thoracoscopic group（ P 〈0.05）.The VAS of thoracoscopic group was lower than that of traditional group at the 1st, 4th and 7th day after operation（ P 〈0.05）. There was no significant difference in lung function between the two groups on the first day after treatment（ P 〉0.05）. The maximal ventilation volume （MVV） on the seventh day after thoracoscopy group was significantly better than that in the traditional group（ P 〈0.05）.The other three lung function data was not significantly different between the two groups（ P 〉0.05）.In the thoracoscopic group, the lung function index was better than that in the traditional group on the thirtieth day after treatment（ P 〈0.01）. The hospitalization time, indwelling time of thoracoscope, operation time, intraoperative bleeding volume, ambulation time and drainage volume of thoracoscope group were better than those of the traditional group（ P 〈0.05）. The incidence of complications such as encapsulated pleural effusion, atelectasis and pulmonary infection in the thoracoscopic group was significantly lower than that in the traditional group（ P 〈0.05）. Conclusion The treatment of multiple rib fractures with thoracoscopic assisted Ni-Ti shape memory alloy rib plate fixation plays an active role in improving the operation related indicators and prognosis and reducing postoperative complications, which is worthy of clinical promotion.