Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservativel...Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservatively. We report a case of a clavicle fracture accompanying severe multiple trauma, which was necessarily treated conservatively because of the severe associated injuries of the patient. The patient was unable to wear a figure-of-8 bandage for the fracture because of the need for complete supine bed rest, due to his other injuries. In this common situation, the clavicle fracture shortened and eventually resulted in the late thoracic outlet syndrome. We believe the cause of this was because a figure-of-8 bandage could not be applied due to the need for complete supine bed rest, and thus was inevitable because of his general condition. This case suggests that the conservative treatment of clavicle fractures, where there is the need for complete bed rest, potentially induces late thoracic outlet syndrome, and that this is indeed a pitfall in the treatment of clavicle fractures in multiple trauma.展开更多
目的:比较全胸腔镜与胸腔镜辅助手术对胸外伤合并多发肋骨骨折患者术后恢复、疼痛和并发症的影响。方法:采取回顾性分析法选取吉安市中心人民医院2021年2月—2023年2月收治的胸外伤合并多发肋骨骨折患者130例,根据手术方法不同将其分为...目的:比较全胸腔镜与胸腔镜辅助手术对胸外伤合并多发肋骨骨折患者术后恢复、疼痛和并发症的影响。方法:采取回顾性分析法选取吉安市中心人民医院2021年2月—2023年2月收治的胸外伤合并多发肋骨骨折患者130例,根据手术方法不同将其分为两组,观察组53例采用全胸腔镜手术治疗,对照组77例采用胸腔镜辅助手术治疗。观察两组围手术期指标、疼痛视觉模拟评分法(VAS)和并发症发生情况。结果:两组手术时间比较,差异无统计学意义(P>0.05)。与对照组相比,观察组手术切口长度较短,术中出血量较少,术后引流管拔管时间和ICU监护时间均较短(P<0.05)。观察组术后3、5、7 d VAS评分均低于对照组(P<0.05)。观察组并发症总发生率(5.66%)低于对照组(18.18%),差异有统计学意义(P<0.05)。结论:在胸外伤合并多发肋骨骨折患者的手术治疗中,全胸腔镜手术患者的恢复、疼痛和并发症发生情况均优于胸腔镜辅助手术。展开更多
Rib fracture is the most common injury in chest trauma.Most of patients with rib fractures were treated conservatively,but up to 50%of patients,especially those with combined injury such as flail chest,presented chron...Rib fracture is the most common injury in chest trauma.Most of patients with rib fractures were treated conservatively,but up to 50%of patients,especially those with combined injury such as flail chest,presented chronic pain or chest wall deformities,and more than 30%had long-term disabilities,unable to retain a full-time job.In the past two decades,surgery for rib fractures has achieving good outcomes.However,in clinic,there are still some problems including inconsistency in surgical indications and quality control in medical services.Before the year of 2018,there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad,focusing on the guidance of the overall treatment decisions and plans;another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures.The Chinese Society of Traumatology,Chinese Medical Association,and the Chinese College of Trauma Surgeons,Chinese Medical Doctor Association organized experts from cardiothoracic surgery,trauma surgery,acute care surgery,orthopedics and other disciplines to participate together,following the principle of evidence-based medicine and in line with the scientific nature and practicality,formulated the Chinese consensus for surgical treatment of traumatic rib fractures(STTRF 2021).This expert consensus put forward some clear,applicable,and graded recommendations from seven aspects:preoperative imaging evaluation,surgical indications,timing of surgery,surgical methods,rib fracture sites for surgical fixation,internal fixation method and material selection,treatment of combined injuries in rib fractures,in order to provide guidance and reference for surgical treatment of traumatic rib fractures.展开更多
目的:探讨胸腔镜辅助肋骨接骨板(Rib bone plate,RBP)治疗外伤性多发肋骨骨折(Trauma rib fracture,TRF)的临床疗效。方法:选取天津市北辰医院收治的TRF患者68例,其中胸腔镜辅助RBP手术组31例,非手术组37例,非手术组即行多头胸带及胸部...目的:探讨胸腔镜辅助肋骨接骨板(Rib bone plate,RBP)治疗外伤性多发肋骨骨折(Trauma rib fracture,TRF)的临床疗效。方法:选取天津市北辰医院收治的TRF患者68例,其中胸腔镜辅助RBP手术组31例,非手术组37例,非手术组即行多头胸带及胸部护板外固定治疗。分析两组治疗后床上坐起时间、下床活动时间、住院时间、痊愈时间;两组治疗后第1、4、7、10天的视觉模拟评分(VAS);两组使用止痛剂频次。结果:腔镜组治疗后床上坐起时间、下床活动时间、住院时间、痊愈时间均显著短于非手术组(P<0.05);1周后胸腔镜组VAS分值显著小于非手术组(P<0.05);治疗后1周后,腔镜组的PaO_2显著高于非手术组(P<0.05);而并发症(12.9%)明显小于非手术组(54.1%)(P<0.05)。结论:采用胸腔镜RBP法治疗胸部创伤肋骨骨折,可有效缩短卧床时间、减少止痛药物用量及并发症发生率,促进患者愈合,极大地提高了患者生活质量,及早回到工作岗位,适合临床广泛应用。展开更多
文摘Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservatively. We report a case of a clavicle fracture accompanying severe multiple trauma, which was necessarily treated conservatively because of the severe associated injuries of the patient. The patient was unable to wear a figure-of-8 bandage for the fracture because of the need for complete supine bed rest, due to his other injuries. In this common situation, the clavicle fracture shortened and eventually resulted in the late thoracic outlet syndrome. We believe the cause of this was because a figure-of-8 bandage could not be applied due to the need for complete supine bed rest, and thus was inevitable because of his general condition. This case suggests that the conservative treatment of clavicle fractures, where there is the need for complete bed rest, potentially induces late thoracic outlet syndrome, and that this is indeed a pitfall in the treatment of clavicle fractures in multiple trauma.
文摘目的:比较全胸腔镜与胸腔镜辅助手术对胸外伤合并多发肋骨骨折患者术后恢复、疼痛和并发症的影响。方法:采取回顾性分析法选取吉安市中心人民医院2021年2月—2023年2月收治的胸外伤合并多发肋骨骨折患者130例,根据手术方法不同将其分为两组,观察组53例采用全胸腔镜手术治疗,对照组77例采用胸腔镜辅助手术治疗。观察两组围手术期指标、疼痛视觉模拟评分法(VAS)和并发症发生情况。结果:两组手术时间比较,差异无统计学意义(P>0.05)。与对照组相比,观察组手术切口长度较短,术中出血量较少,术后引流管拔管时间和ICU监护时间均较短(P<0.05)。观察组术后3、5、7 d VAS评分均低于对照组(P<0.05)。观察组并发症总发生率(5.66%)低于对照组(18.18%),差异有统计学意义(P<0.05)。结论:在胸外伤合并多发肋骨骨折患者的手术治疗中,全胸腔镜手术患者的恢复、疼痛和并发症发生情况均优于胸腔镜辅助手术。
基金supported by the National Trauma Regional Medical Center Major Research Project(co-built by the Municipal Commission)(jjzx2021-gjcsqyylzx01)。
文摘Rib fracture is the most common injury in chest trauma.Most of patients with rib fractures were treated conservatively,but up to 50%of patients,especially those with combined injury such as flail chest,presented chronic pain or chest wall deformities,and more than 30%had long-term disabilities,unable to retain a full-time job.In the past two decades,surgery for rib fractures has achieving good outcomes.However,in clinic,there are still some problems including inconsistency in surgical indications and quality control in medical services.Before the year of 2018,there were 3 guidelines on the management of regional traumatic rib fractures were published at home and abroad,focusing on the guidance of the overall treatment decisions and plans;another clinical guideline about the surgical treatment of rib fractures lacks recent related progress in surgical treatment of rib fractures.The Chinese Society of Traumatology,Chinese Medical Association,and the Chinese College of Trauma Surgeons,Chinese Medical Doctor Association organized experts from cardiothoracic surgery,trauma surgery,acute care surgery,orthopedics and other disciplines to participate together,following the principle of evidence-based medicine and in line with the scientific nature and practicality,formulated the Chinese consensus for surgical treatment of traumatic rib fractures(STTRF 2021).This expert consensus put forward some clear,applicable,and graded recommendations from seven aspects:preoperative imaging evaluation,surgical indications,timing of surgery,surgical methods,rib fracture sites for surgical fixation,internal fixation method and material selection,treatment of combined injuries in rib fractures,in order to provide guidance and reference for surgical treatment of traumatic rib fractures.
文摘目的:探讨胸腔镜辅助肋骨接骨板(Rib bone plate,RBP)治疗外伤性多发肋骨骨折(Trauma rib fracture,TRF)的临床疗效。方法:选取天津市北辰医院收治的TRF患者68例,其中胸腔镜辅助RBP手术组31例,非手术组37例,非手术组即行多头胸带及胸部护板外固定治疗。分析两组治疗后床上坐起时间、下床活动时间、住院时间、痊愈时间;两组治疗后第1、4、7、10天的视觉模拟评分(VAS);两组使用止痛剂频次。结果:腔镜组治疗后床上坐起时间、下床活动时间、住院时间、痊愈时间均显著短于非手术组(P<0.05);1周后胸腔镜组VAS分值显著小于非手术组(P<0.05);治疗后1周后,腔镜组的PaO_2显著高于非手术组(P<0.05);而并发症(12.9%)明显小于非手术组(54.1%)(P<0.05)。结论:采用胸腔镜RBP法治疗胸部创伤肋骨骨折,可有效缩短卧床时间、减少止痛药物用量及并发症发生率,促进患者愈合,极大地提高了患者生活质量,及早回到工作岗位,适合临床广泛应用。
