不同固定方式治疗创伤性多发肋骨骨折的临床疗效

Comparison of Clinical Efficacy of Different Fixation Methods in Treating Traumatic Multiple Rib Fractures

目的比较不同固定方式治疗创伤性多发肋骨骨折的临床疗效。方法回顾性分析2015年1月至2019年10月北京市大兴区人民医院收治的168例创伤性多发肋骨骨折患者的临床资料,按照治疗方式不同分为3组,其中A组采用肋骨固定板术治疗,B组采用环抱式接骨器术治疗,C组采用可吸收肋骨钉术治疗,各56例。比较3组患者临床相关指标、动脉血气分析指标、并发症及临床疗效。结果 B组和C组的呼吸频率恢复正常时间、自主下床活动时间、重症监护病房监护时间及住院时间均显著短于A组[(1.52±0.32) d、(1.50±0.29) d比(2.43±1.47) d,(3.80±1.21) d、(3.78±1.17) d比(9.03±2.73) d,(5.19±1.46) d、(5.23±1.32) d比(8.31±1.78) d,(15.09±4.09) d、(15.83±5.32) d比(24.94±7.21) d](P <0.05)。B组和C组治疗7 d后的动脉血氧分压、动脉血氧饱和度及氧合指数明显高于A组,而动脉血二氧化碳分压明显低于A组(P <0.05)。B组和C组总并发症发生率低于A组[16.07%(9/56)、16.07%(9/56)比30.36%(17/56)](P <0.05)。B组和C组优良率高于A组[60.71%(34/56)、66.07%(37/56)比35.71%(20/56)](P <0.01)。结论三种不同固定方式对创伤性多发肋骨骨折患者均有一定疗效,可吸收肋骨钉术和环抱式接骨器术疗效相当,具有恢复快、并发症少、预后效果好等优点,显著优于肋骨固定板术治疗。

Objective To compare the clinical effect of three different fixation methods of traumatic multiple rib fractures. ZMethods A retrospective analysis on 168 cases of multiple rib fractures admitted to Beijing Daxing District People’s Hospital from Jan. 2015 to Oct. 2019 was done,and the patients were divided into three groups according to the different treatment methods: those treated with rib plates were defined as group A;the patients treated with the embracing bone connector were defined as group B;group C was treated with the absorbable rib nail,56 cases each. The related clinical indexes,arterial blood gas analysis indexes,complications and clinical efficacy of the three groups were compared. Results The recovery time of respiratory rate,voluntary activity time out of bed,intensive care unit monitoring time and hospitalization time in group B and C were significantly lower than those in group A[( 1. 52 ± 0. 32) d,( 1. 50 ± 0. 29) d vs( 2. 43 ±1. 47) d;( 3. 80 ± 1. 21) d,( 3. 78 ± 1. 17) d vs( 9. 03 ± 2. 73) d;( 5. 19 ± 1. 46) d,( 5. 23 ± 1. 32) d vs( 8. 31 ± 1. 78) d;( 15. 09 ± 4. 09) d,( 15. 83 ± 5. 32) d vs( 24. 94 ± 7. 21) d]( P < 0. 05). After 7 days of treatment,the arterial partial pressure of oxygen,arterial oxygen saturation and oxygenation index of group B and C were significantly higher than those of group A,while the arterial partial pressure of carbon dioxide was significantly lower than that of group A( P < 0. 05).The total incidence of complications in group B and C was lower than that in group A[16. 07%( 9/56),16. 07%( 9/56) vs30. 36%( 17/56) ]( P < 0. 05). The excellent and good rates in group B and C were higher than those in group A[60. 71%( 34/56),66. 07%( 37/56) vs 35. 71%( 20/56) ]( P < 0. 01). Conclusion Three different fixation methods are all effective for patients with traumatic multiple rib fractures. Absorbable rib nail and embracing bone connector have the similar effect,featured with quick recovery,fewer complications and better long-term prognosis,which are significantly superior to rib plate fixation.