多发肋骨骨折患者手术时机和合并伤联合手术的临床研究

Optimal operation timing and combined surgery of concomitant injury in patients with multiple rib fractures

目的探讨多发肋骨骨折患者手术治疗的最佳时机,以及合并其他部位骨折患者行同期联合手术的安全性和有效性。方法回顾性分析2007年12月-2017年12月在上海交通大学附属第六人民医院行手术治疗的1573例肋骨骨折患者的临床资料,筛选794例行单纯肋骨骨折手术的患者作为研究对象,根据伤后至手术的时间,分为<3 d组(221例)、3~7 d组(337例)和>7 d组(236例),比较3组患者骨折断端平均固定时间、术后皮下负压引流时间和并发症情况。选择合并其他部位骨折行手术治疗的患者441例,分为同期联合手术组(同期手术组,316例)和分期手术组(125例),比较两组患者的治疗时间、麻醉费用和并发症情况。结果在手术时机的研究中,3~7 d组的患者骨折断端平均固定时间显著短于<3 d组和>7 d组,<3 d组显著短于>7 d组(P值均<0.05)。<3 d组患者的术后皮下负压引流时间显著短于3~7 d组和>7 d组,3~7 d组显著短于>7 d组(P值均<0.05)。3~7 d组患者的术后切口不良事件和肺部感染发生率均显著低于<3 d组和>7 d组(P值均<0.05),<3 d组与>7 d组间的差异均无统计学意义(P值均>0.05)。在合并伤联合手术的研究中,分期手术组的住院时间、术后静脉镇痛药物使用时间均显著长于同期手术组(P值均<0.05),麻醉费用显著高于同期手术组(P<0.05)。两组患者术后切口不良事件和肺部感染发生率的差异均无统计学意义(P值均>0.05)。结论肋骨骨折手术时机的选择对患者的治疗和术后并发症的发生均有影响。伤后3~7 d是肋骨骨折手术的最佳时间。对于合并其他部位骨折的患者,同期联合手术可缩短治疗时间,减少多次麻醉带来的创伤和风险,并降低治疗费用,是经济、有效且安全的。

Objective To explore the optimal timing of operation for multiple rib fractures and the safety and effectiveness of simultaneous combined surgery for patients with other concomitant fractures.Methods Clinical data of 1573 patients undergoing rib fracture surgery from December 2007 to December 2017 were retrospectively analyzed.According to the time from injury to operation,794 patients undergoing simple rib fracture surgery selected as the study objects were divided into three groups:group<3 d(n=221),group 3-7 d(n=337),and group>7 d(n=236).The average operation time of per rib fracture site,postoperative drainage time and complications were compared between groups.At the same time,441 patients with concomitant fractures of other parts were divided into two groups:simultaneous combined operation group(n=316)and staging operation group(n=125);operation time,anesthesia cost and complications were compared between the two groups.Results The group 3-7 d achieved the shortest operation time of per rib fracture site,followed by group<3 d and group>7 d;there were significant differences between groups(all P<0.05).The group<3 d had the shortest postoperative drainage time,followed by group 3-7 d and group>7 d;there were also significant differences between groups(all P<0.05).The incidences of incision adverse events and pulmonary infection in group 3-7 d were significantly lower than those in group<3 d and group>7 d(both P<0.05),but there was no significant difference between group<3 d and group>7 d(both P>0.05).The staging operation group had longer hospital stay and postoperative intravenous analgesia time and more anesthetic cost than the simultaneous combined operation group(all P<0.05),but there was no significant difference in the incidence of incision adverse events or pulmonary infection between the two groups(all P>0.05).Conclusion The operation timing of rib fracture can influence the treatment outcome and postoperative complications.The appropriate operation time for rib fracture is 3-7 days after injury.For the patients with concomitant fractures in the other sites,simultaneously combined operation can shorten the treatment time,reduce the trauma and risk caused by repeated anesthesia,and reduce the cost of treatment,making it an economic,effective and safe procedure.