肋骨三维CT联合超声定位分区域钛板内固定法在肋骨骨折中的应用

Application of Titanium plate internal fixation through CT three dimensional reconstruction and ultrasound in the treatment of rib fracture

目的探讨肋骨三维CT联合超声定位分区域钛板内固定法在肋骨骨折中的应用。方法回顾总结杭州市富阳区第一医院胸外科2017年1月至2018年6月手术治疗的38例多发肋骨骨折患者,其中19例为定位组,采用肋骨三维CT联合超声定位分区域钛板内固定法,定位后分区域(一般选择2～4处邻近的需手术处理的骨折部位为1个区域)做精准的小切口,不同区域的切口采用不同方法游离筋膜以及肌肉组织;另外19例为传统组,采用传统的后外侧切口钛板内固定法。比较两组患者的手术切口长度、每个区域肋骨骨折部位探查固定的时间、术中胸壁是否放置引流管,以及术后疼痛评分。结果所有患者手术顺利完成,胸廓形状恢复正常,反常呼吸消失。随访至术后3个月,复查胸部X线片显示内固定牢固,骨折断端骨性愈合,无严重并发症。与传统组比较,虽然手术固定材料相同,但定位组手术切口长度变小(P<0.01)、探查固定肋骨骨折断端的时间变短、胸壁不需放置引流管(P<0.01)、术后疼痛明显减轻(P<0.01)。结论肋骨三维CT联合超声定位分区域钛板内固定法在肋骨骨折中的应用简单方便,缩短了手术切口和手术时间,胸壁不需放置引流,减轻术后疼痛,可以在肋骨骨折手术中选用。

Objective To investigate the application of Titanium plate internal fixation through CT three dimensional reconstruction and ultrasound in the treatment of rib fracture.Methods The clinical data of 38 patients with rib fracture who underwent Titanium plate internal fixation from January 2017 to June 2018 were collected and retrospectively analyzed. 19 were performed CT three dimensional reconstruction and ultrasound to fix position and make precise incision. Small incisions were made in the each area（generally, 2-4 adjacent fracture sites requiring surgical treatment were selected as 1 area）, different area requiring different muscle sparing techniques.The other 19 patients used traditional posterolateral incision to fix Titanium plate . Lengths of the surgical incision, time of determining the location and to fixing rib fracture in each area, whether or not to place drainage tubes on the chest wall during the operation, and the postoperative pain score were compared between the two groups.Results All operations were successfully completed, with recovered bony thorax and no paradoxical respiration occurred. After 3 months of following up, chest X-Ray film showed bone healing, firm internal fixation, and no serious complication occurred in each case.Even with same fixation material, compared with the traditional method group,in the experimental group, the length of surgical incision was smaller（ P 〈 0.01 ）, the time to determine the location and to fix rib fracture was shorter,the postoperative pain score was much less（ P 〈0.01）,and there was no need to place drainage tubes on the chest wall during the operation（ P 〈0.01）.Conclusions The treatment of rib fracture with Titanium plate through the pre-fixed position by CT three dimensional reconstruction and ultrasound can shorten the length of incision and operation time, reduce the pain with less invasive and muscle-sparing,and having no need to place drainage tube under muscle,which might be a good choice to the treatment of rib fracture.