不同材料内固定手术治疗多发肋骨骨折的临床效果分析

Clinical analysis of different internal fixation materials in the treatment of multiple rib fractures

目的探讨环抱器、锁定板、环抱器-锁定板联合内固定手术治疗创伤性多发肋骨骨折的临床疗效。方法回顾性研究。纳入2018年1月—2020年12月厦门市第五医院胸外科96例创伤性多发肋骨骨折患者的临床资料,其中男67例、女29例,年龄24~79(49.2±13.8)岁,均采用内固定手术治疗。根据内固定材料不同分组:选用镍钛记忆合金环抱器固定37例为环抱器组,解剖型锁定接骨板固定38例为锁定板组,两种材料联合使用21例为联合组。比较三组患者的手术时间、术中出血量、伤口引流量、术后24 h疼痛视觉模拟评分法(VAS)评分、围术期并发症等。结果三组患者的性别、年龄、骨折断端数目、骨折部位、胸部并发症等基线资料差异均无统计学意义(P值均>0.05)。患者手术均顺利,术后随访3~24个月,均未发生环抱器或接骨板、螺钉脱落等。环抱器组患者手术时间为(8.51±0.89)min,优于联合组的(13.50±1.83)min及锁定板组的(15.27±1.42)min,差异均有统计学意义(P值均<0.01);三组中锁定板组术中出血量[(96.34±6.59)mL]最少,与另外两组比较差异均有统计学意义(P值均<0.01)。三组患者伤口引流量、术后24 h疼痛VAS评分以及肺不张、切口感染等并发症差异均无统计学意义(P值均>0.05)。结论采用环抱器、锁定板、环抱器-锁定板联合内固定手术治疗多发肋骨骨折均安全有效,环抱器组所需手术时间最短,锁定板组术中出血量最少。

Objective To investigate the clinical efficacy of an embracing device,locking plate,and the combination of both with internal fixation in the treatment of traumatic multiple rib fractures.Methods The clinical data of 67 males and 29 females,aged from 24-79(49.2±13.8)years and who underwent internal fixation of rib fracture from January 2018 to December 2020 at the Department of Cardiothoracic Surgery of Xiamen Fifth Hospital,were retrospectively analyzed.The cases were classified according to different groups of internal fixation materials include 37 cases with NiTi memory embracing device as the embracing device group,38 cases with anatomical locking plates as the locking plate group,and 21 cases as the combined group.The operative time,intraoperative bleeding,drainage volume and drainage time,pain score,and postoperative complications were recorded.Results Rib fracture fixation was successfully performed in all patients.No significant differences occurred in terms of gender,age,number of fracture ends,fracture location and chest complications,among the three groups(all P values>0.05).The operative time for each fracture(embracing fixator[8.51±0.89]min vs.mix group[13.50±1.83]min and locking plate[15.27±1.42]min)significantly differed(all P values<0.01).Intraoperative bleeding for the various groups(embracing fixator[118.21±7.96]mL vs.mix group[103.74±7.38]mL and locking plate[96.34±6.59]mL)significantly differed(all P values<0.01).No significant difference was observed in the drainage volume,chest pain,atelectasis,and wound infection among the three groups(all P values>0.05).Conclusions The clinical application of an embracing device,locking plate,and the combination of both is safe and effective for the treatment of multiple rib fractures,with the embracing device achieving the shortest operation time.The least amount of intraoperative bleeding is observed for the locking plate group.