Search

Assisted Thoracic Rib Internal Fixation for Flail Chest

目的探討胸腔鏡輔助肋骨內固定術治療連枷胸的優勢及合理性。 方法納入我院2006年1月至2012年1月因外傷導致連枷胸行肋骨內固定手術40例患者，采用胸腔鏡輔助對多發性肋骨骨折連枷胸行NiTi合金肋骨環抱器內固定術20例為胸腔鏡輔助組，其中男14例、女6例，年齡（44.8±7.7）歲；常規開胸切口進胸探查暴露肋骨骨折并行NiTi合金肋骨環抱器內固定術20例為傳統手術組，其中男15例、女5例，年齡（43.0±4.7）歲；比較兩組臨床結果。 結果與傳統手術組相較，胸腔鏡輔助組無再出血，患者能較早脫離呼吸機并適當活動，術后疼痛癥狀較輕，住院時間短，6個月后隨訪無慢性胸痛，傷側胸部切口無麻木感。 結論胸腔鏡輔助肋骨內固定術較常規開胸手術治療多發性肋骨骨折有優勢，值得推廣。

Finite Element Modeling and Clinical Analysis of Internal Fixation of Multiple Rib Fractures and Flail Chest Using Four-claw Ti-planes

Objective To evaluate clinical efficacy of four-claw Ti-planes for internal fixation of multiple rib fractures and flail chest. Methods Clinical data of 93 patients with multiple rib fractures and flail chest who were admittedto Shanghai Pudong Hospital from December 2011 to November 2012 were retrospectively analyzed. There were 78 male and 15 female patients with their age of 20-80 years. All the patients received internal fixation of rib fractures using four-clawTi-planes. Finite element modeling and analysis were performed to investigate biomechanical behaviors of rib fractures after internal fixation with four-claw Ti-planes. Results The average number of rib fractures of the 93 patients was 5.9±2.1，and each patient received 3.8±1.3 four-claw Ti-planes for internal fixation. The operations were performed 6.3±3.2 days after admission. After the rib fractures were fixed with four-claw Ti-planes，rib dislocations and chest-wall collapse of flail chest were restored，and patients’ pain was relieved. Postoperative CT image reconstruction of the chest showed no dislocationor displacement at the fixation areas of the four-claw Ti-planes. Rib fractures were stabilized well，and normal contours of the chest were restored. Finite element analysis showed that the maximum bearable stress of the rib fractures after internal fixation with four-claw Ti-planes was twice as large as normal ribs. Conclusion Clinical outcomes of four-claw Ti-planesfor internal fixation of rib fractures are satisfactory with small incisions and less muscle injury of the chest wall，so this technique deserves wide clinical use.

Efficacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial

ObjectiveTo investigate the efficacy and safety of internal rib fixation for patients with multiple rib fractures. MethodsA total of 141 patients with multiple rib fractures who were admitted to Department of Thoracic Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2010 and January 2013 and whose chest trauma score (AIS-ISS) was 9-20 (16±2) were recruited in this study. Using the random number generator of SPSS, all the patients were randomly divided into an internal fixation group [69 patients including 41 males and 28 females with their age of 25-61 (37±4) years] who underwent internal rib fixation, and a control group [72 patients including 43 males and 29 females with their age of 24-63 (35±5) years] who received conservative therapy. Plasma C-reactive protein (CRP) patients' satisfaction degree with thoracic appearance,incidence of lung infection,pain-relieving efficacy,postoperative chest drainage duration and length of hospital stay were compared between the 2 groups. ResultsPlasma CRP levels of the internal fixation group were not statistically different from those of the control group in 1-3 days after injury (P>0.05) but were significantly lower than those of the control group in 4-12 days after injury (P<0.05). Patients' satisfaction degree with thoracic appearance (97.1% vs. 48.6%,P<0.05) and pain-relieving efficiency (91.3% vs. 68.1%,P<0.05) of the internal fixation group were significantly higher than those of the control group. Incidence of lung infection of the internal fixation group was significantly lower than that of the control group(11.6% vs. 37.5%,P<0.01). Postoperative chest drainage duration [(3±2) d vs. (7±4) d,P<0.05] and length of hospital stay [(9±4) d vs. (15±7) d,P<0.05] of the internal fixation group were significantly shorter than those of the control group. ConclusionsFor patients with multiple rib fractures and stable vital signs,internal fixation surgery is helpful to shorten length of hospital stay, relieve chest pain and improve thoracic appearance. It can also reduce lung inflammation and increase surgical safety so as to improve treatment outcomes of multiple rib fractures.

可吸收髓內釘在多發性肋骨骨折內固定中的應用

【摘 要】 目的 回顧分析可吸收髓內釘在多發性肋骨骨折內固定中的應用方法、指征和療效。 方法 2005 年9 月－ 2007 年2 月，使用可吸收髓內釘行內固定治療16 例多發性肋骨骨折患者。男12 例，女4 例；年齡18 ～ 43 歲。患者均有3 根以上肋骨骨折，均合并血胸，其中10 例為血氣胸；11 例合并肺挫傷；9 例合并脾破裂、鎖骨骨折、骨盆骨折等其他部位的損傷。病程30 min ～ 7 d。手術均采用全身麻醉，健側臥位，經標準外側位切口進行。術后定期隨訪，觀察骨折愈合情況。 結果 患者均獲隨訪6 ～ 20 個月。除1 例因切口感染行二期縫合外，余患者均Ⅰ期愈合，未發生膿胸等并發癥。胸廓塌陷畸形糾正，完整性良好，外觀飽滿。術后6 個月骨折端全部達骨性愈合。 結論 可吸收髓內釘具有良好的組織相容性，可自行降解吸收無需二期手術取出，手術操作簡便，創傷小、愈合時間短，是一種理想的方法。

胸部外傷手術107例臨床分析

多孔有機玻璃板治療多發性肋骨骨折

目的　觀察多孔有機玻璃板治療多發性肋骨骨折的臨床效果。　方法　采用自制多孔有機玻璃板外固定器行肋骨骨折外固定 86例。　結果　 86例患者均治愈出院 ,且住院時間短 ,并發癥少 ,胸廓無畸形。　結論　多孔有機玻璃板外固定器治療多發性肋骨骨折簡便易行 ,該方法安全可靠 ,療效滿意。

負壓封閉引流技術治療多發肋骨骨折內固定術后切口感染所致復雜創面一例

Effectiveness of conservative treatment and open reduction with internal fixation for the treatment of multiple rib fractures: a systematic review

Objectives To systematically review the efficacy of conservative treatment and open reduction with internal fixation for multiple rib fractures. Methods We searched WanFang Data, CNKI, VIP, PubMed, EMbase, The Cochrane Library and Web of Science from inception to December 2017 to collect studies on conservative treatment and open reduction with internal fixation for multiple rib fractures. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.3 software was used for meta-analysis. Results A total of 16 studies were included, involving 1 374 patients, 723 patients in the surgical group and 651 patients in the conservative group. The meta-analysis showed that the length of stay in the ICU (MD=–3.41, 95%CI –4.92 to –2.43, P<0.000 01), total length of stay (MD=–7.60, 95 %CI–10.67 to–4.53,P<0.000 01), incidence of pulmonary arylene (RR=0.40, 95%CI 0.29 to 0.54,P<0.000 01), incidence of lung infections (RR=0.43, 95%CI 0.30 to 0.61,P<0.000 01), and incidence of chest wall malformation (RR=0.05, 95%CI 0.03 to 0.11,P<0. 0.000 01) in the surgical group were superior to the conservative group. Conclusions Compared with conservative treatment, open reduction with internal fixation can significantly improve the recovery time of patients with multiple rib fractures, reduce hospitalization time, the incidence of perioperative complications, and significantly enhance the prognosis of patients, which is more conducive to the rehabilitation of patients.

Tunnel-type open reduction and internal fixation of rib fractures with titanium locking plate

Objective To investigate the tunnel-type open reduction and internal fixation of rib fractures (ORIF) with titanium locking plate in traumatic rib fractures. Methods Clinical data of 10 patients with multiple rib fractures from June 2016 to January 2017 in the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were analyzed. There were 6 males and 4 males with an average age of 38.5±9.0 years (range, 30–63 years). All patients underwent emergency treatment, chest CT and ultrasound examination before they admitted to the hospital. According to rib fractures and injuries, patients were given the tunnel-type ORIF of rib fractures with titanium locking plates, the chest tube and negative suction drainage. The patients were followed up over three months. Results All patients were cured. There was no complication during follow-up. No wound infection and death occurred. Postoperative three-month follow-up showed that chest pain was significantly relieved without pulmonary atelectasis and pleural effusion or other complications. Conclusion Tunnel-type internal fixation of rib fractures with titanium locking plates is effective, which can quickly restore the stability and integrity of the thorax. Surgical procedure is simple and can get fast postoperative recovery to improve the patient's quality of life.

SU,s全胸腔鏡下肋骨骨折骨板骨釘胸腔內植入固定技術的臨床應用

目的　探討全胸腔鏡下肋骨骨折骨板骨釘胸腔內植入固定技術的操作方法及適應證。 方法　2009年10月至2011年10月赤峰學院附屬醫院3例有移位的肋骨骨折患者，其中男2例、女1例，平均年齡36歲；采用SU , s全胸腔鏡下肋骨骨折骨板骨釘胸腔內植入固定技術進行手術，3例均有胸腔內活動性出血和胸內凝血塊，術中應用自主設計專利器械進行操作，針對如何控制肋間血管出血、游離顯露肋骨斷端、牽開骨折斷端、對位固定、腔鏡下肋骨板內植入等階段設計了全新的手術方法。 結果　采用胸腔鏡下內植入式鎳鈦記憶合金肋骨板胸腔內植入1例，固定肋骨1根，手術時間125 min；采用可吸收肋骨釘固定2例，1例固定2根肋骨，手術時間110 min；1例固定1根肋骨，手術時間90 min。 3例患者手術順利，恢復良好，無并發癥發生，痊愈出院，隨訪3個月骨折無移位。結論　SU , s全胸腔鏡下肋骨骨折骨板骨釘胸腔內植入固定技術從技術角度在部分選擇的患者中可行，但還不能取代在重癥復合胸外傷常規開胸手術，還需進一步改進。