Found：Army Logistics Research Project (CLJ20J023) Short-term effect of 3D printing external fixed guide combined with video-assisted thoracic surgery treatment of flail chest: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Maolin , HU Meng , BAO Chuanen , LUO Junlong , ZHUO Longcai ,  GUO Ming

Department of Cardiothoracic Surgery, Xiamen University Affiliated Chenggong Hospital (Army 73S1 Group Military Hospital), Xiamen, 361003, Fujian, P. R. China;

Corresponding?author：

GUO Ming, Email: 13358378777@163.com

Keywords：

3D printing; guide; video-assisted thoracic surgery; flail chest

DOI：

10.7507/1007-4848.202406014

Video：

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Objective To explore the early clinical effect of 3D printing external fixed guide combined with video-assisted thoracic surgery (VATS) in the treatment of flail chest, and to provide evidence for the promotion of this technology. Methods Patients with flail chest treated in our hospital from January 2010 to January 2023 were retrospectively selected as the study objects. The trial group was treated with 3D printed external fixation guide combined with VATS, and the control group was treated with open reduction internal fixation. Operation time, intraoperative blood loss, closed thoracic drainage time, thoracic volume recovery, visual analogue scale (VAS) score 1 month after surgery and complications were compared between the two groups. Results A total of 40 patients were included, 20 in each group. In the experimental group, there were 13 males and 7 females, with an average age of 45.7±3.8 years. In the control group, there were 14 males and 6 females, with an average age of 47.3±4.1 years. There was no statistical difference in gender, age, number of rib fractures or VAS between the two groups (P>0.05). The surgery was successful in both groups, the wounds healed in stage Ⅰ, and the pain symptoms were significantly reduced. No postoperative complications occurred in the trial group, while chronic pain occurred in 1 patient, fracture malunion occurred in 1 patient and incision infection occurred in 1 patient in the control group, with a complication rate of 15.0%. Operation time, intraoperative blood loss and closed thoracic drainage time in trial group were lower than those in control group (P<0.05). There was no statistical difference in the recovery of thoracic volume and VAS at 1 month after operation (P>0.05). Conclusion 3D printing external fixation guide combined with VATS in the treatment of flail chest has satisfactory early curative effect, which has the advantages of minimally invasive, high efficiency, rapid recovery and reducing postoperative complications. This method can effectively reconstruct the shape of the chest, restore the volume of the chest.

1.	Alanwer KM, Refat AM, Negm EM. Impact of flail chest injury on morbidity and outcome: Ten years' experience at a tertiary care hospital in a developing country. BMC Anesthesiol, 2023, 23(1): 229.
2.	Richman AP, Brahmbhatt TS, Litle VR. Let's not fail the flail chest. Ann Thorac Surg, 2022, 113(6): 1865-1866.
3.	Benjamin E, Recinos G, Aiolfi A, et al. Flail chest: Less deadly than originally thought. World J Surg, 2018, 42(12): 3927-3931.
4.	Ferreira ROM, Pasqualotto E, Viana P, et al. Surgical versus non-surgical treatment of flail chest: A meta-analysis of randomized controlled trials. Eur J Trauma Emerg Surg, 2023, 49(6): 2531-2541.
5.	Poirier WJ, Vacca J. Flail chest. Nursing. 2013, 43(12): 10-11.
6.	Yahn CA, McNally AP, Deivert K, et al. Outcomes of trauma patients with flail chest and surgical rib stabilization. Am Surg, 2022, 88(4): 810-812.
7.	Song X, Li H, Chen Q, et al. Predicting pneumonia during hospitalization in flail chest patients using machine learning approaches. Front Surg, 2023, 9: 1060691.
8.	Sawyer E, Wullschleger M, Muller N, et al. Surgical rib fixation of multiple rib fractures and flail chest: A systematic review and meta-analysis. J Surg Res, 2022 Aug: 276: 221-234.276-221.
9.	王慶淮, 譚寧, 蒙偉平, 等. 創傷性連枷胸伴肺挫傷的診療進展. 中華胸部外科電子雜志, 2016, 3(3): 182-186.Wang WQ, Tan N, Meng WP, et al. Progress in diagnosis and treatment of traumatic flailchest complicated with pulmonary contusion. Chin J Thorac Surg, 2016, 3(3): 182-186.
10.	Xia H, Zhu D, Li J, et al. Current status and research progress of minimally invasive surgery for flail chest. Exp Ther Med, 2020, 19(1): 421-427.
11.	Ozdemir S, Kose S, Ozel Bilgi D, et al. The outcomes of chest wall stabilization in flail chest patients in the intensive care unit. Sisli Etfal Hastan Tip Bul, 2021, 55(4): 495-502.
12.	Dantis K, Brahmachari S, Raju A, et al. An innovative technique of chest wall stabilization and reconstruction in traumatic flail chest: The figure-of-eight suture with polypropylene mesh and musculofascial flap. Chin J Traumatol, 2022, 25(2): 122-124.
13.	van Gool MH, van Roozendaal LM, Vissers YLJ, et al. VATS-assisted surgical stabilization of rib fractures in flail chest: 1-year follow-up of 105 cases. Gen Thorac Cardiovasc Surg, 2022, 70(11): 985-992.
14.	杜雪婷, 楊洋, 黃文華, 等. 基于醫學影像技術的3D打印臨床應用與突破. 中國組織工程研究, 2021, 25(18): 2887-2894.Du XT, Yang Y, Huang WH, et al. Clinical application and breakthrough of three-dimensional printing based on medical imaging technology. Chin J Tissue Engin Res, 2021, 25(18): 2887-2894.
15.	Daskal Y, Paran M, Korin A, et al. Multiple rib fractures: Does flail chest matter? Emerg Med J, 2021, 38(7): 496-500.
16.	林希達, 龔輝, 沈叢林, 等. 連枷胸手術治療臨床效果分析. 交通醫學, 2023, 37(5): 463-467.Lin XD, Gong H, Shen CL, et al. Analysis of clinical effect of flail chest surgery. Med J Comm, 2023, 37(5): 463-467.
17.	沈旭, 朱云柯, 張含露, 等. 多發肋骨骨折及連枷胸的臨床治療研究進展. 中國胸心血管外科臨床雜志, 2021, 28(7): 858-862.Shen X, Zhu YK, Zhang HL, et al. Progresses in clinical treatment of multiple rib fractures and flail chest. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(7): 858-862.
18.	Dehghan N, Mah JM, Schemitsch EH, et al. Operative stabilization of flail chest injuries reduces mortality to that of stable chest wall injuries. J Orthop Trauma, 2018, 32(1): 15-21.
19.	王慶淮, 譚寧. 微創快速康復外科技術治療創傷性連枷胸的效果分析. 中華肺部疾病雜志(電子版), 2020, 13(1): 89-91.Wang WQ, Tan N. Analysis of the effect of minimally invasive rapid rehabilitation surgery on traumatic flail chest. Chin J Lung Dis (Electronic Edition), 2020, 13(1): 89-91.
20.	Dorn P, Pfister S, Oberhaensli S, et al. Operative versus non-operative management of rib fractures in flail chest after cardiopulmonary resuscitation manoeuvres. Interact Cardiovasc Thorac Surg, 2022, 34(5): 768-774.
21.	Kocher GJ, Sharafi S, Azenha LF, et al. Chest wall stabilization in ventilator-dependent traumatic flail chest patients: Who benefits? Eur J Cardiothorac Surg, 2017, 51(4): 696-701.
22.	張斌, 齊琦, 晁棟, 等. 微創治療連枷胸的手術時機選擇及術后發生并發癥的危險因素分析. 創傷外科雜志, 2023, 25(6): 432-436.Zhang B, Qi Q, Chao D, et al. Surgical timing of minimally invasive treatment of flail chest and risk factor for postoperative pulmonary complications. J Traum Surg, 2023, 25(6): 432-436.
23.	Lodhia JV, Konstantinidis K, Papagiannopoulos K. Surgical management of multiple rib fractures/flail chest. J Thorac Dis, 2019, 11(4): 1668-1675.
24.	Marasco SF, Nguyen Khuong J, Fitzgerald M, et al. Flail chest injury-changing management and outcomes. Eur J Trauma Emerg Surg, 2023, 49(2): 1047-1055.
25.	Owattanapanich N, Lewis MR, Benjamin ER, et al. Surgical Rib Fixation in Isolated Flail Chest Improves Survival. Ann Thorac Surg, 2022, 113(6): 1859-1865.
26.	Taheri Akerdi A, Mousavi SM, Abdolrahimzadehfard H, et al. Flail chest: Definition and management protocols need to be modified. J Trauma Acute Care Surg, 2021, 91(2): e50.
27.	Wang N, Bachman KC, Linden PA, et al. Age as a barrier to surgical stabilization of rib fractures in patients with flail chest. Am Surg, 2023, 89(4): 927-934.
28.	Wessell JE, Pereira MP, Eriksson EA, et al. Rib fixation for flail chest physiology and the facilitation of safe prone spinal surgery: Illustrative case. J Neurosurg Case Lessons, 2022, 4(21): CASE22337.
29.	宋斌, 施永周, 陳明志, 等. 一種鎖定加壓胸壁外固定裝置在連枷胸早期救治中的臨床效果分析. 創傷外科雜志, 2024, 26(01): 37-42.Song B, Shi YZ, Chen ZM, et al. Clinical analysis of a locking compression chest wall external fixation device in early treatment of flail chest. J Traum Surg, 2024, 26(01): 37-42.

1. Alanwer KM, Refat AM, Negm EM. Impact of flail chest injury on morbidity and outcome: Ten years' experience at a tertiary care hospital in a developing country. BMC Anesthesiol, 2023, 23(1): 229.
2. Richman AP, Brahmbhatt TS, Litle VR. Let's not fail the flail chest. Ann Thorac Surg, 2022, 113(6): 1865-1866.
3. Benjamin E, Recinos G, Aiolfi A, et al. Flail chest: Less deadly than originally thought. World J Surg, 2018, 42(12): 3927-3931.
4. Ferreira ROM, Pasqualotto E, Viana P, et al. Surgical versus non-surgical treatment of flail chest: A meta-analysis of randomized controlled trials. Eur J Trauma Emerg Surg, 2023, 49(6): 2531-2541.
5. Poirier WJ, Vacca J. Flail chest. Nursing. 2013, 43(12): 10-11.
6. Yahn CA, McNally AP, Deivert K, et al. Outcomes of trauma patients with flail chest and surgical rib stabilization. Am Surg, 2022, 88(4): 810-812.
7. Song X, Li H, Chen Q, et al. Predicting pneumonia during hospitalization in flail chest patients using machine learning approaches. Front Surg, 2023, 9: 1060691.
8. Sawyer E, Wullschleger M, Muller N, et al. Surgical rib fixation of multiple rib fractures and flail chest: A systematic review and meta-analysis. J Surg Res, 2022 Aug: 276: 221-234.276-221.
9. 王慶淮, 譚寧, 蒙偉平, 等. 創傷性連枷胸伴肺挫傷的診療進展. 中華胸部外科電子雜志, 2016, 3(3): 182-186.Wang WQ, Tan N, Meng WP, et al. Progress in diagnosis and treatment of traumatic flailchest complicated with pulmonary contusion. Chin J Thorac Surg, 2016, 3(3): 182-186.
10. Xia H, Zhu D, Li J, et al. Current status and research progress of minimally invasive surgery for flail chest. Exp Ther Med, 2020, 19(1): 421-427.
11. Ozdemir S, Kose S, Ozel Bilgi D, et al. The outcomes of chest wall stabilization in flail chest patients in the intensive care unit. Sisli Etfal Hastan Tip Bul, 2021, 55(4): 495-502.
12. Dantis K, Brahmachari S, Raju A, et al. An innovative technique of chest wall stabilization and reconstruction in traumatic flail chest: The figure-of-eight suture with polypropylene mesh and musculofascial flap. Chin J Traumatol, 2022, 25(2): 122-124.
13. van Gool MH, van Roozendaal LM, Vissers YLJ, et al. VATS-assisted surgical stabilization of rib fractures in flail chest: 1-year follow-up of 105 cases. Gen Thorac Cardiovasc Surg, 2022, 70(11): 985-992.
14. 杜雪婷, 楊洋, 黃文華, 等. 基于醫學影像技術的3D打印臨床應用與突破. 中國組織工程研究, 2021, 25(18): 2887-2894.Du XT, Yang Y, Huang WH, et al. Clinical application and breakthrough of three-dimensional printing based on medical imaging technology. Chin J Tissue Engin Res, 2021, 25(18): 2887-2894.
15. Daskal Y, Paran M, Korin A, et al. Multiple rib fractures: Does flail chest matter? Emerg Med J, 2021, 38(7): 496-500.
16. 林希達, 龔輝, 沈叢林, 等. 連枷胸手術治療臨床效果分析. 交通醫學, 2023, 37(5): 463-467.Lin XD, Gong H, Shen CL, et al. Analysis of clinical effect of flail chest surgery. Med J Comm, 2023, 37(5): 463-467.
17. 沈旭, 朱云柯, 張含露, 等. 多發肋骨骨折及連枷胸的臨床治療研究進展. 中國胸心血管外科臨床雜志, 2021, 28(7): 858-862.Shen X, Zhu YK, Zhang HL, et al. Progresses in clinical treatment of multiple rib fractures and flail chest. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(7): 858-862.
18. Dehghan N, Mah JM, Schemitsch EH, et al. Operative stabilization of flail chest injuries reduces mortality to that of stable chest wall injuries. J Orthop Trauma, 2018, 32(1): 15-21.
19. 王慶淮, 譚寧. 微創快速康復外科技術治療創傷性連枷胸的效果分析. 中華肺部疾病雜志(電子版), 2020, 13(1): 89-91.Wang WQ, Tan N. Analysis of the effect of minimally invasive rapid rehabilitation surgery on traumatic flail chest. Chin J Lung Dis (Electronic Edition), 2020, 13(1): 89-91.
20. Dorn P, Pfister S, Oberhaensli S, et al. Operative versus non-operative management of rib fractures in flail chest after cardiopulmonary resuscitation manoeuvres. Interact Cardiovasc Thorac Surg, 2022, 34(5): 768-774.
21. Kocher GJ, Sharafi S, Azenha LF, et al. Chest wall stabilization in ventilator-dependent traumatic flail chest patients: Who benefits? Eur J Cardiothorac Surg, 2017, 51(4): 696-701.
22. 張斌, 齊琦, 晁棟, 等. 微創治療連枷胸的手術時機選擇及術后發生并發癥的危險因素分析. 創傷外科雜志, 2023, 25(6): 432-436.Zhang B, Qi Q, Chao D, et al. Surgical timing of minimally invasive treatment of flail chest and risk factor for postoperative pulmonary complications. J Traum Surg, 2023, 25(6): 432-436.
23. Lodhia JV, Konstantinidis K, Papagiannopoulos K. Surgical management of multiple rib fractures/flail chest. J Thorac Dis, 2019, 11(4): 1668-1675.
24. Marasco SF, Nguyen Khuong J, Fitzgerald M, et al. Flail chest injury-changing management and outcomes. Eur J Trauma Emerg Surg, 2023, 49(2): 1047-1055.
25. Owattanapanich N, Lewis MR, Benjamin ER, et al. Surgical Rib Fixation in Isolated Flail Chest Improves Survival. Ann Thorac Surg, 2022, 113(6): 1859-1865.
26. Taheri Akerdi A, Mousavi SM, Abdolrahimzadehfard H, et al. Flail chest: Definition and management protocols need to be modified. J Trauma Acute Care Surg, 2021, 91(2): e50.
27. Wang N, Bachman KC, Linden PA, et al. Age as a barrier to surgical stabilization of rib fractures in patients with flail chest. Am Surg, 2023, 89(4): 927-934.
28. Wessell JE, Pereira MP, Eriksson EA, et al. Rib fixation for flail chest physiology and the facilitation of safe prone spinal surgery: Illustrative case. J Neurosurg Case Lessons, 2022, 4(21): CASE22337.
29. 宋斌, 施永周, 陳明志, 等. 一種鎖定加壓胸壁外固定裝置在連枷胸早期救治中的臨床效果分析. 創傷外科雜志, 2024, 26(01): 37-42.Song B, Shi YZ, Chen ZM, et al. Clinical analysis of a locking compression chest wall external fixation device in early treatment of flail chest. J Traum Surg, 2024, 26(01): 37-42.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesFound：Army Logistics Research Project (CLJ20J023) Short-term effect of 3D printing external fixed guide combined with video-assisted thoracic surgery treatment of flail chest: A retrospective cohort study

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