| 胸腔镜微创手术治疗多发肋骨骨折并连枷胸的临床效果 |
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投稿时间：2023-12-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 周攀 |
ZHOU Pan |
武汉科技大学附属汉阳医院胸外科, 湖北 武汉 430050 |
Department of Thoracic Surgery, Hanyang Hospital, Wuhan University of Science and Technology, Wuhan 430050, Hubei, China |
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| 吴中权 |
WU Zhong-quan |
武汉科技大学附属汉阳医院胸外科, 湖北 武汉 430050
武汉科技大学 职业危害识别与控制湖北省重点实验室, 湖北 武汉 430065 |
Department of Thoracic Surgery, Hanyang Hospital, Wuhan University of Science and Technology, Wuhan 430050, Hubei, China
Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, Hubei, China |
wzqlpwkf@163.com |
| 朱杰 |
ZHU Jie |
武汉科技大学附属汉阳医院胸外科, 湖北 武汉 430050 |
Department of Thoracic Surgery, Hanyang Hospital, Wuhan University of Science and Technology, Wuhan 430050, Hubei, China |
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| 程玲玲 |
CHENG Ling-ling |
武汉科技大学附属汉阳医院胸外科, 湖北 武汉 430050 |
Department of Thoracic Surgery, Hanyang Hospital, Wuhan University of Science and Technology, Wuhan 430050, Hubei, China |
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| 舒圣 |
SHU Sheng |
武汉科技大学附属汉阳医院胸外科, 湖北 武汉 430050 |
Department of Thoracic Surgery, Hanyang Hospital, Wuhan University of Science and Technology, Wuhan 430050, Hubei, China |
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| 期刊信息：《中国骨伤》2025年，第38卷，第1期，第47-54页 |
| DOI：10.12200/j.issn.1003-0034.20230319 |
| 基金项目:武汉科技大学职业危害识别与控制湖北省重点实验室“联合基金”课题(编号:JF2023-G02) |
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中文摘要:
目的: 探讨胸腔镜下镍钛形状记忆合金环抱接骨板微创手术与保留肋骨骨膜内固定术对多发肋骨骨折(multiple rib fractures，MRF)并连枷胸患者的临床效果。
方法: 对2019年1月至2022年12月采用胸腔镜微创手术和保留肋骨骨膜内固定术治疗的MRF并连枷胸的患者100例进行回顾性分析，其中男54例，女46例;年龄20~65(38.0±18.0)岁;病程8~21 d。根据手术方式不同分为对照组和研究组，各50例。对照组男23例，女27例，年龄(38.35±18.05)岁，使用保留肋骨骨膜内固定术。研究组男31例，女19例，年龄(38.15±17.99)岁，使用胸腔镜下镍钛形状记忆合金环抱接骨板微创内固定术。比较两组手术前后肺功能指标、心电监护指标、疼痛程度、炎性因子水平、并发症、康复指标及疗效。
结果: 所有患者获得6个月的随访。术后3 d，对照组与观察组心率[(102.43±13.74)次/分 vs (86.26±8.06)次/分]、呼吸频率[(28.45±3.40)次/分 vs (22.05±2.85)次/分]、血氧饱和度[(89.68±3.66)% vs (98.46±4.84)%]、静息痛[(3.5±0.5)分 vs (2.6±0.6)分]、运动痛[(3.6±0.5) vs (2.5±0.5)]，差异均有统计学意义(P均<0.05);两组白细胞介素-6(interleukin- 6，IL-6)为[(102.30±17.00) pg·ml-1 vs (85.68±21.20) pg·ml-1]、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)为[(33.44±4.85) pg·ml-1 vs (18.14±4.28) pg·ml-1]均高于术前，C反应蛋白(C-reactive protein，CRP)为[(75.51±10.54) mg·L-1 vs (60.75±9.84) mg·L-1]均低于术前，研究组低于对照组(P<0.05)。术后10 d，两组呼气峰值流速[(3.31±0.52) L·S-1 vs (5.69±0.74)L·S-1]、用力呼气容积[(1.46±0.29) L vs (2.06±0.38) L]、用力肺活量[(2.68±0.95) L vs (4.26±1.05) L]高于术前，且研究组均高于对照组(P<0.05)。研究组术后并发症6例，低于对照组14例(P<0.05)，研究组骨痂形成时间(9.50±1.40) d、骨折愈合时间(72.20±8.32) d，均短于对照组(11.35±2.15)、(93.70±9.90) d (P<0.001)。
结论: 相较于传统保留肋骨骨膜内固定术，采用胸腔镜下镍钛形状记忆合金环抱接骨板微创内固定治疗的MRF并连枷胸患者的治疗效果更好，原因在于其手术创伤更小，疼痛程度及炎性反应更轻，术后肺部并发症少，肺功能更快更好地康复，从而促进患者康复。 |
| 【关键词】胸腔镜下微创手术 保留肋骨骨膜内固定术 多发肋骨骨折 连枷胸 |
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| Thoracoscopic minimally invasive surgery for the treatment of flail chest with multiple rib fractures |
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ABSTRACT
Objective To investigate the clinical efficacy of thoracoscopic minimally invasive surgery with nickel-titanium shape memory alloy wrap bone plate versus rib periosteal internal fixation in patients with multiple rib fractures (MRF) and flail chest.
Methods A retrospective analysis was performed on 100 patients with MRF and flail chest treated with thoracoscopic minimally invasive surgery and internal fixation with rib fracture preservation between January 2019 and December 2022,including 54 males and 46 females,aged from 20 to 65 years old,with an average age of (38.0±18.0) years old. The duration of the disease ranged from 8 to 21 days. According to the different surgical methods,the patients were divided into control group and study group,with 50 patients in each group. The control group consisted of 23 males and 27 females,with an average age of (38.35±18.05) years old,who underwent rib preservation periosteal internal fixation. In the study group,there were 31 males and 19 females,with an average age of (38.15±17.99) years old,treated with thoracoscopic nickel-titanium shape memory alloy circumferential bone plate. The pulmonary function indices,electrocardiographic monitoring indices,pain severity,levels of inflammatory factors,complications,rehabilitation indices,and therapeutic efficacy were compared between the two groups before and after treatment.
Results All patients were followed up for 6 months. After 3 days of treatment,the heart rate of both groups was (102.43±13.74) beats per minute vs (86.26±8.06) beats per minute,respiratory rate (28.45±3.40) breaths per minute vs (22.05±2.85) breaths per minute,blood oxygen saturation (89.68±3.66)% vs (98.46±4.84)%,rest pain (3.5±0.5) points vs (2.6±0.6) points,movement pain (3.6±0.5) points vs (2.5±0.5) points,and these differences were statistically significant(P<0.05). The levels of Interleukin-6 (IL-6) (102.30±17.00) pg·ml-1 vs (85.68±21.20) pg·ml-1 and tumor necrosis factor-alpha (TNF-α)(33.44±4.85) pg·ml-1 vs (18.14±4.28) pg·ml-1 in both groups exhibited an increase post-treatment,while the C-reactive protein (CRP) (75.51±10.54) mg·L-1 vs (60.75±9.84) mg·L-1 demonstrated a decrease compared to pre-treatment levels. Furthermore,the study group displayed significantly lower levels than the control group (P<0.05). After 10 days of treatment,the peak expiratory flow rate (3.31±0.52) L·s-1 vs (5.69±0.74) L·s-1,forced expiratory volume (1.46±0.29) L vs (2.06±0.38) L,and forced vital capacity (2.68±0.95) L vs (4.26±1.05) L of both groups exhibited significant improvements compared to pre-treatment levels. Moreover,the study group demonstrated significantly higher values than the control group (P<0.05). The incidence of postoperative complications in the study group was significantly lower compared to the control group (6 cases vs 14 cases,P<0.05). Additionally,the duration of bone callus formation(9.50±1.40) days and fracture healing (72.20±8.32) days in the study group was significantly shorter compared to the control group(11.35±2.15) days,(93.70±9.90) days (P<0.001).
Conclusion Compared with traditional rib-preserving internal fixation,patients with MRF and flail chest treated with minimally invasive internal fixation with thoracoscopic nickel-titanium shape memory alloy surround bone plate have better therapeutic effect,because of less surgical trauma,less pain and inflammatory reaction,fewer postoperative pulmonary complications,faster and better recovery of lung function,and thus promote the recovery of patients. |
| KEY WORDS Thoracoscopic minimally invasive surgery Rib-preserving periosteal fixation Multiple rib fractures Flail chest |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 周攀,吴中权,朱杰,程玲玲,舒圣.胸腔镜微创手术治疗多发肋骨骨折并连枷胸的临床效果[J].中国骨伤,2025,38(1):47~54 |
| 英文格式: | ZHOU Pan,WU Zhong-quan,ZHU Jie,CHENG Ling-ling,SHU Sheng.Thoracoscopic minimally invasive surgery for the treatment of flail chest with multiple rib fractures[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(1):47~54 |
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