外伤性多发性肋骨骨折合并脾破裂的急诊诊断及临床治疗

Emergency Diagnosis and Clinical Treatment of Traumatic Multiple Rib Fractures with Spleen Rupture

目的探讨外伤性多发性肋骨骨折合并脾破裂的急诊诊断及临床治疗。方法该院2019年7月—2020年9月收治外伤性多发性肋骨骨折合并脾破裂患者120例,以脾脏受损情况分为轻度组与重度组,每组60例,根据骨折肋骨固定装置差异将重度组分为对照组(n=25)与治疗组(n=35),对照组采取记忆合金接骨板,治疗组采取可吸收性肋骨钉。对比轻度组与重度组术前诊断情况包括骨折部位、骨折数及并发症情况,分析治疗后轻度组与重度组手术情况包括术后并发症、术后住院时间及胸腔闭式引流时间等,并分析对照组与治疗组围术期情况。结果轻度组与重度组入院时骨折发生部位在单侧、双侧分布对比,差异无统计学意义(P>0.05);并发症发生情况及骨折数对比,差异无统计学意义(P>0.05)。治疗后,重度组住院时间长于轻度组,重度组并发症发生风险(20.00%)高于轻度组(5.00%),差异有统计学意义(χ^(2)=6.171,P<0.05),重度组胸腔闭式引流时间长于轻度组,差异有统计学意义(P<0.05)。治疗组术后下床活动时间短于对照组,差异有统计学意义(P<0.05),手术失血量及手术时间对比,差异无统计学意义(P>0.05)。结论外伤性多发性肋骨骨折合并脾破裂急诊诊断可通过CT及B超进行诊断,治疗预后与患者脾破裂程度具有紧密联系,且脾破裂越严重,并发症发生风险越高,需对患者进行全方位诊断,以此提升急救成功率,其中骨折肋骨固定装置中的可吸收肋骨钉可缩短下床活动所需时间,并可避免二次手术取出内固定的痛苦。

Objective To investigate the emergency diagnosis and clinical treatment of traumatic multiple rib fractures with spleen rupture.Methods From July 2019 to September 2020,120 patients with traumatic multiple rib fractures combined with spleen rupture were treated in the hospital.According to the spleen damage,they were divided into mild group and severe group,each group included 60 patients.The severe group was divided into the control group(n=25)and the treatment group(n=35)according to the difference of fracture rib fixation device.The control group received memory alloy bone plate,and the treatment group received absorbable rib nails.The preoperative diagnosis including fracture location,number of fractures and complications were compared between the mild group and the severe group.The operation conditions of mild group and severe group after treatment,including postoperative complications,postoperative hospital stay and thoracic closed drainage time were analyzed.The perioperative conditions of the control group and the treatment group were also analyzed.Results There was no statistically significant difference between the mild group and the severe group in the unilateral and bilateral distribution of fractures at admission(P>0.05).There was no statistically significant difference in the incidence of complications and the number of fractures(P>0.05).After treatment,the hospital stay in the severe group was longer than that in the mild group,and the risk of complications in the severe group was 20.00% higher than that in the mild group 5.00%,and the difference was statistically significant(χ^(2)=6.171,P<0.05).The time of closed thoracic drainage in the severe group was longer than that in the mild group,and the difference was statistically significant(P<0.05).The postoperative ambulation time of the treatment group was shorter than that of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the amount of blood loss and operation time during operation(P>0.05).Conclusion The emergency diagnosis of traumatic multiple rib fractures with spleen rupture can be diagnosed by CT and B-ultrasound,and the prognosis of treatment is closely related to the degree of spleen rupture.And the more severe the spleen rupture,the higher the risk of complications,and it is necessary to conduct a comprehensive diagnosis of the patient to improve the success rate of first aid.Among them,the absorbable rib nail in the fracture rib fixation device can shorten the time required for getting out of bed and avoid the pain of taking out the internal fixation through the second operation.