胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗多发性肋骨骨折的临床研究
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摘要
目的研究胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗多发性肋骨骨折(fracture of multiple ribs,FMR)的临床效果。方法 2013年1月—2017年6月河南省人民医院收治的FMR患者136例,其中男性88例,女性48例;年龄24~79岁,平均43.38岁。致伤因素:道路交通伤82例,高处坠落伤34例,砸伤20例。依据随机数字表法分为实验组(n=68)与对照组(n=68),实验组行胸腔镜下形状记忆肋骨环抱接骨板内固定治疗,对照组行开胸形状记忆肋骨环抱接骨板内固定治疗。观察两组术中出血量、手术时间、术后呼吸机时间、引流管放置时间、住院时间,两组术前、术后7d白介素-6(IL-6)、白介素-8(IL-8)、C-反应蛋白(CRP)等炎性因子水平及肺活量,两组术前、术后1、3、5、7d疼痛评分,术后肺不张、肺炎发生情况。结果实验组术中出血量、手术时间、术后呼吸机时间、引流管放置时间、住院时间分别为(189.76±19.53)m L、(58.97±5.92)min、(1.97±0.21)d、(2.33±0.24)d、(7.92±0.83)d,均低于对照组的(221.68±22.65)m L、(80.76±8.18)min、(3.69±0.38)d、(4.79±0.49)d、(13.19±1.33)d,P<0.05。术后7d,实验组IL-6、IL-8、CRP分别为(90.85±9.11)ng/L、(112.86±11.21)ng/L、(4.74±0.48c)mg/L,均低于对照组的(136.57±13.62)ng/L、(228.42±22.49)ng/L、(6.64±0.68)mg/L,肺活量(2116.76±213.65)m L高于对照组(1789.95±181.75)m L(P<0.05)。术后1、3、5、7d,实验组疼痛评分(疼痛强度数字评分法评价)均低于对照组(P<0.05)。实验组术后肺不张、肺炎发生率(4.41%、7.35%)低于对照组(14.71%、20.59%),P<0.05。结论胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗FMR创伤小,固定牢固,术后恢复快,值得临床应用。
Objective To study the clinical effect of thoracoscopic nickel-titanium shape memory alloys internal fixation in treating fracture of multiple ribs(FMR). Methods A total of 136 FMR patients were admitted to our hospital from Jan. 2013 to Jun. 2017. Among them were 88 male cases and 48 female cases with an average age of 43. 38(24-79) years. The injured factors included traffic injury in 82 cases,high fall injury in 34 cases,and crashing injury in 20 cases. They were selected and divided into experimental group(n = 68) and control group(n =68) using the random number table method. Patients in experimental group were performed thoracoscopic nickel-titanium shape memory alloys internal fixation,and those in control group were performed transthoracic nickel-titanium internal fixation. The intraoperative blood loss,operation time,postoperative ventilation time,drainage tube placement time,hospital stays,the level of inflammatory factors such as IL-6,IL-8 and CRP and vital capacity before operation and 7 d after operation,the pain score before operation and 1 d,3 d,5 d and 7 d after operation,the postoperative pulmonary atelectasis and the incidence of pneumonia of the two groups were observed. Results The intraoperative blood loss,operation time,postoperative ventilation time,drainage tube placement time,hospital stays in the experimental group were less than those in the control group(189. 76 ± 19. 53) m L vs.(221. 68 ± 22. 65) m L,(58. 97 ±5. 92) min vs.(80. 76 ± 8. 18) min,(1. 97 ± 0. 21) d vs.(3. 69 ± 0. 38) d,(2. 33 ± 0. 24) d vs.(4. 79 ± 0. 49) d,(7. 92 ± 0. 83) d vs.(13. 19 ± 1. 33),P < 0. 05). At 7 d after operation,the levels of IL-6,IL-8 and CRP in the experimental group were lower than those in the control group(90. 85 ± 9. 11) ng/L vs.(136. 57 ± 13. 62) ng/L,(112. 86 ± 11. 21) ng/L vs.(228. 42 ± 22. 49) ng/L,(4. 74 ± 0. 48 c) mg/L vs.(6. 64 ± 0. 68) mg/L,and the vital capacity was higher than that in control group(2116. 76 ± 213. 65) m L vs.(1789. 95 ± 181. 75) m L,P < 0. 05).At 1 d,3 d,5 d and 7 d after operation,the pain scores in experimental group were lower than those in control group(P < 0. 05). The incidences of postoperative pulmonary atelectasis and pneumonia in experimental group(4. 41%,7. 35%) were lower than those in control group(14. 71%,20. 59%)(P < 0. 05). Conclusion Thoracoscopic nickel-titanium shape memory alloys internal fixation in treating FMR generates less trauma,firm fixation and fast postoperative recovery,so the therapy is worthy of clinical application.
Objective To study the clinical effect of thoracoscopic nickel-titanium shape memory alloys internal fixation in treating fracture of multiple ribs(FMR). Methods A total of 136 FMR patients were admitted to our hospital from Jan. 2013 to Jun. 2017. Among them were 88 male cases and 48 female cases with an average age of 43. 38(24-79) years. The injured factors included traffic injury in 82 cases,high fall injury in 34 cases,and crashing injury in 20 cases. They were selected and divided into experimental group(n = 68) and control group(n =68) using the random number table method. Patients in experimental group were performed thoracoscopic nickel-titanium shape memory alloys internal fixation,and those in control group were performed transthoracic nickel-titanium internal fixation. The intraoperative blood loss,operation time,postoperative ventilation time,drainage tube placement time,hospital stays,the level of inflammatory factors such as IL-6,IL-8 and CRP and vital capacity before operation and 7 d after operation,the pain score before operation and 1 d,3 d,5 d and 7 d after operation,the postoperative pulmonary atelectasis and the incidence of pneumonia of the two groups were observed. Results The intraoperative blood loss,operation time,postoperative ventilation time,drainage tube placement time,hospital stays in the experimental group were less than those in the control group(189. 76 ± 19. 53) m L vs.(221. 68 ± 22. 65) m L,(58. 97 ±5. 92) min vs.(80. 76 ± 8. 18) min,(1. 97 ± 0. 21) d vs.(3. 69 ± 0. 38) d,(2. 33 ± 0. 24) d vs.(4. 79 ± 0. 49) d,(7. 92 ± 0. 83) d vs.(13. 19 ± 1. 33),P < 0. 05). At 7 d after operation,the levels of IL-6,IL-8 and CRP in the experimental group were lower than those in the control group(90. 85 ± 9. 11) ng/L vs.(136. 57 ± 13. 62) ng/L,(112. 86 ± 11. 21) ng/L vs.(228. 42 ± 22. 49) ng/L,(4. 74 ± 0. 48 c) mg/L vs.(6. 64 ± 0. 68) mg/L,and the vital capacity was higher than that in control group(2116. 76 ± 213. 65) m L vs.(1789. 95 ± 181. 75) m L,P < 0. 05).At 1 d,3 d,5 d and 7 d after operation,the pain scores in experimental group were lower than those in control group(P < 0. 05). The incidences of postoperative pulmonary atelectasis and pneumonia in experimental group(4. 41%,7. 35%) were lower than those in control group(14. 71%,20. 59%)(P < 0. 05). Conclusion Thoracoscopic nickel-titanium shape memory alloys internal fixation in treating FMR generates less trauma,firm fixation and fast postoperative recovery,so the therapy is worthy of clinical application.
引文
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[2]Lee SK,Kang do K.Nuss procedure for surgical stabilization of flail chest with horizontal sternal body fracture and multiple bilateral rib fractures[J].J Thorac Dis,2016,8(6):e390-392.
[3]李世健.切开复位内固定治疗外伤性多发肋骨骨折临床疗效及手术时机评价[J].中华创伤杂志,2016,32(6):533-535.
[4]任守阳,黄健,张晓飞,等.电视胸腔镜手术及常规手术治疗多发性肋骨骨折的对比分析[J].中国胸心血管外科临床杂志,2014,21(1):33-35.
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[6]刘福升,徐建华.电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折合并血胸36例[J].中国微创外科杂志,2015,15(4):336-338.
[7]高从荣,聂弘.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[J].安徽医学,2014,35(12):1693-1695.
[8]周德存,胡晓俭,孟凡东,等.胸腔镜辅助同期肋骨内固定手术治疗多发性肋骨骨折65例[J].安徽医学,2015,36(7):874-875.
[9]苟亚军,尹昌林,陈翔宇.胸腔镜手术与传统剖胸手术对多发肋骨骨折合并肺撕裂伤的急诊手术治疗比较分析[J].重庆医学,2016,45(19):2614-2616.
[10]Tarng YW,Liu YY,Huang FD,et al.The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure[J].Surg Endosc,2016,30(1):388-395.
[11]牛世海.胸腔镜辅助下小切口镍钛记忆合金肋骨接骨板固定术治疗多发肋骨骨折的疗效研究[J].河北医药,2016,38(3):368-370.
[12]赖小刚,王宪东.镍钛记忆合金环抱器治疗多发性肋骨骨折的临床分析[J].临床军医杂志,2015,43(1):85-86.
[13]王斌强.镍钛环抱式接骨器内固定修复多发性肋骨骨折:与克氏针应用安全性比较[J].中国组织工程研究,2015,19(21):3419-3423.
[14]孙发适.镍钛合金抓握式接骨板治疗多发性肋骨骨折[J].中华实验外科杂志,2015,32(2):431.
[15]李少民,张晋,姜建涛,等.创伤性连枷胸不同时机手术固定疗效的对比[J].国际外科学杂志,2013,40(7):458-461.
[16]牛世海.胸腔镜辅助下小切口镍钛记忆合金肋骨接骨板固定术治疗多发肋骨骨折的疗效研究[J].河北医药,2016,38(3):368-370.
[17]向毅,杨泉,郭小川,等.胸腔镜与常规手术治疗多发性肋骨骨折并肺撕裂伤的临床对照研究[J].实用医院临床杂志,2017,14(4):184-186.
[2]Lee SK,Kang do K.Nuss procedure for surgical stabilization of flail chest with horizontal sternal body fracture and multiple bilateral rib fractures[J].J Thorac Dis,2016,8(6):e390-392.
[3]李世健.切开复位内固定治疗外伤性多发肋骨骨折临床疗效及手术时机评价[J].中华创伤杂志,2016,32(6):533-535.
[4]任守阳,黄健,张晓飞,等.电视胸腔镜手术及常规手术治疗多发性肋骨骨折的对比分析[J].中国胸心血管外科临床杂志,2014,21(1):33-35.
[5]De Freest 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.
[6]刘福升,徐建华.电视胸腔镜联合肋骨接骨板治疗多发性肋骨骨折合并血胸36例[J].中国微创外科杂志,2015,15(4):336-338.
[7]高从荣,聂弘.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[J].安徽医学,2014,35(12):1693-1695.
[8]周德存,胡晓俭,孟凡东,等.胸腔镜辅助同期肋骨内固定手术治疗多发性肋骨骨折65例[J].安徽医学,2015,36(7):874-875.
[9]苟亚军,尹昌林,陈翔宇.胸腔镜手术与传统剖胸手术对多发肋骨骨折合并肺撕裂伤的急诊手术治疗比较分析[J].重庆医学,2016,45(19):2614-2616.
[10]Tarng YW,Liu YY,Huang FD,et al.The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure[J].Surg Endosc,2016,30(1):388-395.
[11]牛世海.胸腔镜辅助下小切口镍钛记忆合金肋骨接骨板固定术治疗多发肋骨骨折的疗效研究[J].河北医药,2016,38(3):368-370.
[12]赖小刚,王宪东.镍钛记忆合金环抱器治疗多发性肋骨骨折的临床分析[J].临床军医杂志,2015,43(1):85-86.
[13]王斌强.镍钛环抱式接骨器内固定修复多发性肋骨骨折:与克氏针应用安全性比较[J].中国组织工程研究,2015,19(21):3419-3423.
[14]孙发适.镍钛合金抓握式接骨板治疗多发性肋骨骨折[J].中华实验外科杂志,2015,32(2):431.
[15]李少民,张晋,姜建涛,等.创伤性连枷胸不同时机手术固定疗效的对比[J].国际外科学杂志,2013,40(7):458-461.
[16]牛世海.胸腔镜辅助下小切口镍钛记忆合金肋骨接骨板固定术治疗多发肋骨骨折的疗效研究[J].河北医药,2016,38(3):368-370.
[17]向毅,杨泉,郭小川,等.胸腔镜与常规手术治疗多发性肋骨骨折并肺撕裂伤的临床对照研究[J].实用医院临床杂志,2017,14(4):184-186.