胸腔镜胸内固定术与传统开胸手术治疗多发肋骨骨折的疗效比较

Comparative Analysis of the Efficacy of Thoracoscopic Intrathoracic Fixation Versus Traditional Thoracotomy for Multiple Rib Fractures

目的探讨胸腔镜下胸内固定技术治疗多发肋骨骨折的临床疗效。方法回顾性比较我科2019年8月~2022年4月93例多发肋骨骨折的临床资料,按照手术方法分为胸腔镜组(n=50)和传统组(n=43)。胸腔镜组应用记忆合金肋骨接骨板行胸腔镜下胸腔内固定术,传统组应用记忆合金肋骨接骨板行传统开胸切开复位内固定术,比较2组患者手术时间、术中出血量、术后住院时间、术后带管时间、术后疼痛时间、术后引流量及术后并发症。结果胸腔镜组手术时间[(96.1±24.7)min vs.(110.2±29.1)min,t=-2.526,P=0.013]、术中出血量[(76.0±38.4)ml vs.(140.2±80.8)ml,t=-4.767,P=0.000]、术后带管时间[(3.9±1.6)d vs.(6.2±1.8)d,t=-2.739,P=0.008]、术后引流量[(132.4±53.9)ml vs.(157.9±50.5)ml,t=-2.345,P=0.021]、术后住院时间[(5.8±2.5)d vs.(9.7±2.5)d,t=-4.397,P=0.000]、疼痛时间[(4.9±1.2)d vs.(5.8±1.4)d,t=-2.199,P=0.030]显著短于/少于传统组。胸腔镜组术后肺炎、肺不张、胸腔积液发生率显著低于传统组(P<0.05)。术后1、3、12个月随访,肋骨接骨板固定牢靠,无一例移位、变形、脱落。结论胸腔镜下胸内固定术治疗多发肋骨骨折具有创伤小、疼痛轻,恢复快、临床效果确切等优点,值得临床推广。

Objective To explore the clinical efficacy of video-assisted thoracoscopic intrathoracic fixation in the treatment of multiple rib fractures.Methods Clinical data of 93 cases of multiple rib fractures in our department from August 2019 to April 2022 were retrospectively compared.They were divided into thoracoscopic group(n=50)and traditional group(n=43)according to surgical methods.In the thoracoscopic group,the memory alloy rib plate was used for thoracoscopic intrathoracic fixation,and in the traditional group,the memory alloy rib plate was used for traditional thoracotomy to treat multiple rib fractures.The operation time,intraoperative blood loss,postoperative hospital stay,postoperative catheter duration,postoperative pain time,postoperative drainage volume,and postoperative complications were compared between the two groups.Results As compared with the traditional group,the thoracoscopic group had significantly shorter operation time[(96.1±24.7)min vs.(110.2±29.1)min,t=-2.526,P=0.013],less intraoperative blood loss[(76.0±38.4)ml vs.(140.2±80.8)ml,t=-4.767,P=0.000],shorter postoperative catheter duration[(3.9±1.6)d vs.(6.2±1.8)d,t=-2.739,P=0.008],less postoperative drainage volume[(132.4±53.9)ml vs.(157.9±50.5)ml,t=-2.345,P=0.021],shorter postoperative hospital stay[(5.8±2.5)d vs.(9.7±2.5)d,t=-4.397,P=0.000],and shorter pain time[(4.9±1.2)d vs.(5.8±1.4)d,t=-2.199,P=0.030].The incidence of postoperative pneumonia,atelectasis,and pleural effusion in the thoracoscopic group was significantly lower than that in the traditional group(P<0.05).Follow-ups at 1,3,and 12 months after surgery showed that the rib plate was firmly fixed without any displacement,deformation,or detachment.Conclusion Video-assisted thoracoscopic intrathoracic fixation in the treatment of multiple rib fractures has advantages of less trauma,less pain,faster recovery,and definite clinical results,which is worthy of clinical application and promotion.