单孔胸腔镜辅助肋骨骨折内固定术
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摘要
目的总结单孔胸腔镜辅助外伤多发性肋骨骨折内固定手术30例的临床经验。方法分别于2011年10月至2012年3月、2013年12月至2014年5月在两个单位完成单孔胸腔镜辅助肋骨骨折内固定手术30例。胸外伤原因:车祸15例,工伤8例,摔伤5例(包括骑马坠落伤3例),斗殴2例。所有患者为肋骨多根或多处骨折,肋骨骨折数>3根,最多双侧14根肋骨骨折。前20例应用镍钛合金形状记忆肋骨环抱接骨板,后10例应用纯钛接骨板,均可满意固定肋骨骨折端。通过单孔胸腔镜清除胸腔内血块、切割缝合器闭合肺裂伤。胸腔镜灯光可以精确引导并切开皮肤和胸壁组织,行内固定术。术中通过胸腔镜单孔放置胸腔闭式引流管。结果全组患者围手术期无死亡病例,术后平均住院5.8 d,均康复出院。随访至今除有3例患者内固定处疼痛需处理外,其余患者均安全存活。结论单孔胸腔镜辅助肋骨骨折内固定术是更精确、创伤更小,兼顾胸腔内处理的手术方法。
Objective To summarize the clinical experiences of 30 patients with multiple rib fractures who underwent internal fixation surgery assisted by video-assisted thoracic surgery. Methods 30 cases of single-port thoracoscopic assisted internal fixation surgery of rib fractures were accomplished in two hospitals, Renji Hospital Affiliated to School of Medicine Shanghai Jiaor Tong University and Yulong Naxi Autonomous Country People's Hospital University respectively from October 2011 to March 2012 and December 2013 to May 2014.Causes of chest trauma are as following: 15 cases of traffic accident, 8 cases of industrial injury, 5 cases of fall injury(including 3 cases of horse riding injury), 2 cases of affray. Fractured ribs in all patients were more than 3, with a maximum case of 14 fractured bilateral ribs. The first 20 cases in Renji Hospital used Nitinol alloy shape memory ribs to encircle the bone plate, and the other 10 cases used pure titanium bone plate, all of which could be used to fix the fracture end of the rib satisfactorily.The intrapleural blood clot was removed, and the pulmonary laceration was closed by incision suture device under single-port thoracoscopy. Thoracoscopic light can accurately guide and cut open the skin and chest wall tissue in internal fixation surgery.Closed thoracic drainage tube was placed through thoracoscopy's single port intraoperatively. Results No death occurred during perioperative period.The average postoperative hospitalization was 5.8 days. All recovered and discharged from hospital. Up to now, all patients survived safely except for 3 cases of pain at the internal fixation site that needed to be treated. Conclusions Single-port thoracoscopic assisted internal fixation surgery for rib fractures has advantages such as more accurate in the treatment,and smaller wounds after treatment.
Objective To summarize the clinical experiences of 30 patients with multiple rib fractures who underwent internal fixation surgery assisted by video-assisted thoracic surgery. Methods 30 cases of single-port thoracoscopic assisted internal fixation surgery of rib fractures were accomplished in two hospitals, Renji Hospital Affiliated to School of Medicine Shanghai Jiaor Tong University and Yulong Naxi Autonomous Country People's Hospital University respectively from October 2011 to March 2012 and December 2013 to May 2014.Causes of chest trauma are as following: 15 cases of traffic accident, 8 cases of industrial injury, 5 cases of fall injury(including 3 cases of horse riding injury), 2 cases of affray. Fractured ribs in all patients were more than 3, with a maximum case of 14 fractured bilateral ribs. The first 20 cases in Renji Hospital used Nitinol alloy shape memory ribs to encircle the bone plate, and the other 10 cases used pure titanium bone plate, all of which could be used to fix the fracture end of the rib satisfactorily.The intrapleural blood clot was removed, and the pulmonary laceration was closed by incision suture device under single-port thoracoscopy. Thoracoscopic light can accurately guide and cut open the skin and chest wall tissue in internal fixation surgery.Closed thoracic drainage tube was placed through thoracoscopy's single port intraoperatively. Results No death occurred during perioperative period.The average postoperative hospitalization was 5.8 days. All recovered and discharged from hospital. Up to now, all patients survived safely except for 3 cases of pain at the internal fixation site that needed to be treated. Conclusions Single-port thoracoscopic assisted internal fixation surgery for rib fractures has advantages such as more accurate in the treatment,and smaller wounds after treatment.
引文
1 杨春锋. 抓卧式镍钛记忆合金肋骨接骨板对多发肋骨骨折患者的治疗效果[J]. 中国医药导报,2014,11(30):54.
2 中华医学会创伤学分会交通伤与创伤数据库学组,创伤急救与多发伤学组.严重胸部创伤救治规范[J].中华创伤杂志, 2013,29(5):385-390.
3 吴小勤, 张广云, 薛瑞. 电视胸腔镜辅助下多根多处肋骨骨折内固定[J]. 岭南现代临床外科, 2013, 13(2):133-135.
4 徐伟峰, 王新连, 顾家榕,等. 胸腔镜辅助下肋骨骨折内固定治疗体会[J]. 创伤外科杂志, 2015, 17(6):554-554.
5 张晓飞, 黄健, 任守阳. 单操作孔胸腔镜辅助下行肋骨环抱器内固定术治疗多发性肋骨骨折[J]. 四川医学, 2013, 34(9):1291-1292.
6 Ke S, Duan H, Cai Y, et al.Thoracoscopy-assisted minimally invasive surgical stabilization of the anterolateral flail chest using Nussbars[J].Ann Thorac Surg. 2014 Jun;97(6):2179-82.
7 Demmy TL, Yendamuri S, Hennon MW, et al. Thoracoscopic maneuvers for chest wall resection and reconstruction.[J]. J Thorac Cardiovasc Surg, 2012,144(3):52-57
8 张洪波,王建东,左占杰. 多发肋骨骨折 76 例治疗分析[J]. 武警后勤学院学报:医学版,2016,25(7):571-573
9 Fowler TT, Taylor B, Bellino MJ, et al. Surgical treatment of failt chest and rib fractures[J]. J Am Acad Orthop Surg, 2014,22(12):751-760.
10 Pieracci FM, Lin Y, Rodil M, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures[J]. J Trauma Acute Care Surg, 2016 ,80(2):187-194.
11 DeFreest L, Tafen M, Bhakta A, et al. Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest[J]. Am J Surg, 2016, 211(4):761-767.
12 Doben AR, Pieracci FM. Reply to "Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest" by DeFreest et al[J]. Am J Surg, 2017, 213(6):1189.
13 莫安胜, 罗玉忠, 杨小平,等. 单操作孔胸腔镜手术的临床观察[J]. 微创医学, 2013, 8(1):31-32.
14 崔建国, 许志华, 孙春媛,等. 电视胸腔镜辅助下钛镍合金接骨板内固定治疗多发肋骨骨折的临床研究[J]. 临床肺科杂志, 2011, 16(12):1859-1860.
15 陆熠, 盛波, 丁一,等. 胸腔镜辅助内固定术与传统手术治疗肋骨骨折的效果观察[J]. 中国综合临床, 2015, 31(8):753-755.
16 赖海银,陈梦君,曹成章.胸腔镜辅助下记忆合金环抱器治疗多根多发肋骨骨折的可行性分析[J]. 医学理论与实践,2016,29(17):3014-3016.
17 吴科杰,万强,戚雅秀,等.早期胸腔镜辅助镍钛记忆合金内固定在肋骨骨折合并血气胸中的临床应用[J]. 深圳中西医结合杂志,2016,26(20):155-156.
18 Funaki S, Inoue M, Minami M, et al. Video-assistedthora-coscopic resection of fractured ribs to prevent descending aorta injury in patient with chest trauma[ J].Ann Thorac Cardiovasc Surg, 2014,20(2):173-174
19 Chou YP, Kuo LC, Soo KM, et al. The role of repairing lung lacerations during videoassisted thoracoscopicsurgery evacuations for retained haemothorax caused byblunt chest trauma[J]. Eur J Cardiothorac Surg, 2014,46(1):107-111.
20 王通,宋金涛,闫天生,等. 电视胸腔镜辅助爪形肋骨接骨板内固定治疗多发肋骨骨折合并血气胸[J]. 中国微创外科杂志,2016,16(3):245.
2 中华医学会创伤学分会交通伤与创伤数据库学组,创伤急救与多发伤学组.严重胸部创伤救治规范[J].中华创伤杂志, 2013,29(5):385-390.
3 吴小勤, 张广云, 薛瑞. 电视胸腔镜辅助下多根多处肋骨骨折内固定[J]. 岭南现代临床外科, 2013, 13(2):133-135.
4 徐伟峰, 王新连, 顾家榕,等. 胸腔镜辅助下肋骨骨折内固定治疗体会[J]. 创伤外科杂志, 2015, 17(6):554-554.
5 张晓飞, 黄健, 任守阳. 单操作孔胸腔镜辅助下行肋骨环抱器内固定术治疗多发性肋骨骨折[J]. 四川医学, 2013, 34(9):1291-1292.
6 Ke S, Duan H, Cai Y, et al.Thoracoscopy-assisted minimally invasive surgical stabilization of the anterolateral flail chest using Nussbars[J].Ann Thorac Surg. 2014 Jun;97(6):2179-82.
7 Demmy TL, Yendamuri S, Hennon MW, et al. Thoracoscopic maneuvers for chest wall resection and reconstruction.[J]. J Thorac Cardiovasc Surg, 2012,144(3):52-57
8 张洪波,王建东,左占杰. 多发肋骨骨折 76 例治疗分析[J]. 武警后勤学院学报:医学版,2016,25(7):571-573
9 Fowler TT, Taylor B, Bellino MJ, et al. Surgical treatment of failt chest and rib fractures[J]. J Am Acad Orthop Surg, 2014,22(12):751-760.
10 Pieracci FM, Lin Y, Rodil M, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures[J]. J Trauma Acute Care Surg, 2016 ,80(2):187-194.
11 DeFreest L, Tafen M, Bhakta A, et al. Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest[J]. Am J Surg, 2016, 211(4):761-767.
12 Doben AR, Pieracci FM. Reply to "Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest" by DeFreest et al[J]. Am J Surg, 2017, 213(6):1189.
13 莫安胜, 罗玉忠, 杨小平,等. 单操作孔胸腔镜手术的临床观察[J]. 微创医学, 2013, 8(1):31-32.
14 崔建国, 许志华, 孙春媛,等. 电视胸腔镜辅助下钛镍合金接骨板内固定治疗多发肋骨骨折的临床研究[J]. 临床肺科杂志, 2011, 16(12):1859-1860.
15 陆熠, 盛波, 丁一,等. 胸腔镜辅助内固定术与传统手术治疗肋骨骨折的效果观察[J]. 中国综合临床, 2015, 31(8):753-755.
16 赖海银,陈梦君,曹成章.胸腔镜辅助下记忆合金环抱器治疗多根多发肋骨骨折的可行性分析[J]. 医学理论与实践,2016,29(17):3014-3016.
17 吴科杰,万强,戚雅秀,等.早期胸腔镜辅助镍钛记忆合金内固定在肋骨骨折合并血气胸中的临床应用[J]. 深圳中西医结合杂志,2016,26(20):155-156.
18 Funaki S, Inoue M, Minami M, et al. Video-assistedthora-coscopic resection of fractured ribs to prevent descending aorta injury in patient with chest trauma[ J].Ann Thorac Cardiovasc Surg, 2014,20(2):173-174
19 Chou YP, Kuo LC, Soo KM, et al. The role of repairing lung lacerations during videoassisted thoracoscopicsurgery evacuations for retained haemothorax caused byblunt chest trauma[J]. Eur J Cardiothorac Surg, 2014,46(1):107-111.
20 王通,宋金涛,闫天生,等. 电视胸腔镜辅助爪形肋骨接骨板内固定治疗多发肋骨骨折合并血气胸[J]. 中国微创外科杂志,2016,16(3):245.