环抱器联合肋间神经阻滞在多发性肋骨骨折中的应用

Application of embracing fixator combined with intercostal nerve block in multiple rib fractures

目的探讨肋骨环抱器及肋间神经阻滞治疗多发性肋骨骨折患者的临床疗效。方法选取宿州市第一人民医院2015年10月—2019年7月收治的90例多发性肋骨骨折患者,按抽签法随机分成3组,每组30例。A组患者应用外固定非手术治疗,B组患者应用记忆合金环抱器内固定手术治疗,C组患者应用肋骨环抱器内固定联合肋间神经阻滞手术治疗,3组患者性别、年龄等一般情况比较差异均无统计学意义(均P>0.05);观察指标:比较3组患者住院时间、治疗前后肺功能[动脉血氧分压(PaO_2)及二氧化碳分压(PaCO_2)]变化情况、下床活动时间、胸部并发症发生率及患者治疗1周时疼痛情况,手术患者术后24 h时患者疼痛评分情况。结果 B组及C组患者治疗1周时疼痛评分、住院时间及下床活动时间、治疗后PaO_2及PaCO_2变化明显优于A组,差异有统计学意义(均P<0.01);C组患者在治疗1周时疼痛评分、治疗后PaO_2及PaCO_2情况及术后24 h时疼痛评分优于B组(均P<0.01);同时B组及C组患者在治疗期间胸部并发症发生率少于A组,C组患者胸部并发症发生率较B组进一步降低。结论肋骨环抱器治疗多发性肋骨骨折疗效确切,安全可靠;联合肋间神经阻滞能进一步减轻患者术后疼痛症状,加快患者伤后肺功能的恢复,并进一步减少胸部并发症发生。

Objective To investigate the clinical effect of intercostal nerve block and rib embracing fixator in the treatment of multiple rib fractures.Methods A total of 90 patients with multiple RIB fracture were randomly divided into ABC group(30 cases in each group).Patients in Group A were treated with external fixation,patients in Group B were treated with internal fixation of memory alloy embracing fixator,and patients in Group C were treated with internal fixation of rib embracing fixator combined with intercostal nerve block,there was no significant difference in age and other general conditions(P>0.05).The changes of PaO2 and PaCO2,the time of movement,the incidence of chest complications and pain in one week after treatment in A,B,C group were compared with those in the two groups at 24 hours after operation.Results The changes of PaO2 and PaCO2 in Group B and Group C were significantly better than those in group A after one week treatment(all P<0.01).The pain score of Group C,PaO2 and PaCO2,24 hours after treatment were significantly higher than those of Group B(all P<0.01).At the same time,the incidence of thoracic complications in Group B and C was significantly lower than that in Group A,and the incidence of thoracic complications in Group C was further lower than that in group B.Conclusion The treatment of multiple rib fractures with rib embracing fixator is effective,safe and reliable,and combined with intercostal nerve block can further reduce the postoperative pain symptoms and speed up the recovery of lung function,and further reduce the incidence of thoracic complications,worthy of clinical application and promotion.