ObjectiveTo compare clinical outcomes between video-assisted thoracoscopic surgery (VATS) and conventional surgery for the treatment of multiple rib fractures. MethodsA total of 173 consecutive patients with multiple rib fractures were admitted to Dujiangyan People's Hospital from January 2010 to December 2012. There were 122 males and 51 females with their age of 19-71 (41.3±7.1) years. According to different treatment strategies, all the patients were divided into 3 groups:conservative treatment group (83 patients with a mean of 4.9±1.3 fractured ribs, including 20 patients with flail chest), conventional surgery group (41 patients with a mean of 5.2±1.1 fractured ribs, including 11 patients with flail chest) and VATS group (49 patients with a mean of 5.3±1.5 fractured ribs, including 14 patients with flail chest). Length of hospital stay, duration of postoperative pain, incision length, operation time, chest drainage duration and morbidity were compared among the 3 groups. ResultsThe incision length (5.2±1.5 cm vs. 8.5±2.3 cm, P=0.031), operation time (1.1±0.3 hours vs. 1.8±0.2 hours, P=0.003), chest drainage duration (0.3±0.0 day vs. 3.2±1.1 days, P=0.007) and length of hospital stay (13.7±1.5 days vs. 17.3±2.3 days, P=0.017) of VATS group were significantly shorter than those of the conventional surgery group. A total of 159 patients were followed up, and chest x-ray was examined at 1, 3 and 6 months after discharge. After 3 months, bone callus formation was evident around the rib fractures in chest x-ray in patients undergoing surgery, while bone union with deformity was shown in some patients of the conservative group. ConclusionWith the development of various internal fixation materials, surgical internal fixation has become a trend for patients with multiple rib fractures, and VATS internal fixation is minimally invasive with satisfactory clinical outcomes.
目的探讨多发性肋骨骨折切口及手术入路选择 方法回顾性分析赤峰学院附属医院2000年6至2013年12月手术治疗58例多发性肋骨骨折患者的临床资料，其中开胸组46例，胸腔镜组12例，男43例、女15例，年龄36（15～61）岁。 结果开胸手术组平均手术时间152 min，平均住院时间16 d；腔镜镜手术组平均手术时间125 min，平均住院时间12.5 d。46例开胸手术患者中44例术后胸壁稳定，自主呼吸排痰良好，16例肺挫伤较重有呼吸综合征（ARDS）倾向，术后经12～148 h呼吸机支持后恢复，1例死于合并食管下段破裂，术后第3 d突发腹腔大出血，分析为外伤性腹主动脉瘤破裂。3例患者切口部分裂开，均为环抱器骨板，1例胸骨骨折胸大肌皮瓣拉拢缝合治愈，另2例中1例取出裸露骨板，1例换药及二期缝合治愈。45例患者返院及电话随访6个月至3年，开胸组39例胸壁稳定，胸部X线片固定处均有骨伽形成，全组无难以耐受的肋间神经痛，腔镜手术组切口及固定肋骨处愈合良好。 结论实际操作中可根据骨折形态特点以后外侧“～”切口及垂直切口为基础做多种变形。胸腔镜下手术切口设计时要根据骨折断端位置，可能出现的胸内脏器血管损伤，综合考虑切口布局；最好操作孔及进镜孔处有骨折断端，方便内外结合固定，节省手术时间；同时要考虑出血脏器损伤的部位，方便止血修补或中转开胸；操作孔可以3～5个。
目的探讨多发性肋骨骨折合理治疗方法。 方法回顾性分析山东省日照市岚山区人民医院心胸外科2010年1月至2013年10月115例胸部闭合性损伤患者的临床资料，其中男81例、女34例，年龄19～75岁，平均36.2岁。 结果CT三维重建能够准确判断肋骨骨折情况及胸廓变形情况，然后设置小切口选择性手术内固定肋骨骨折，患者经过手术治疗后全部痊愈，无死亡病例，患者术后疼痛明显减轻，胸廓形状基本恢复，呼吸功能及咳嗽功能基本恢复，住ICU时间8～72（10± 2）h，住院时间9～21（12± 1）d。随访6～18个月，随访率88.7%（102/115）；患者对手术治疗效果满意度为95.1%（97/102）。 结论多发性肋骨骨折患者利用螺旋CT三维重建立体定位后采用小切口手术内固定治疗是一种安全且符合微创原则的治疗方法。
ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.
Objective To compare clinical outcomes between the performed titanium locking plate and nickel-titanium memory alloy embracing fixator for the treatment of multiple rib fractures, and to select a better internal fixator for multiple rib fractures. Methods A total of 206 consecutive patients with multiple rib fractures were admitted to Department of Cardiothoracic Surgery in Beijing Luhe Hospital of Capital Medical University from October 2011 to September 2016. According to different treatment strategies, the patients were divided into 2 groups: a performed titanium locking plate group (a titanium plate group, n=105) and a nickel-titanium memory alloy embracing fixator group (an embracing fixator group, n=101). There were 82 males and 23 females with a mean age of 46.5±9.7 years ranging from 23 to 65 years in the titanium plate group, and 83 males and 18 females with a mean age of 44.7±10.3 years ranging from 19 to 63 years in the embracing fixator group. The preoperative data, curative outcomes, visual analogue scale (VAS) and postoperative complications were compared between the two groups. Results There was no statistical difference in the preoperative data between the two groups, and all patients successfully completed the operation. Compared with the embracing fixator group, the incision length and operation time were shorter, intraoperative bleeding and VAS score were less, and curative outcome was better in the titanium plate group. Conclusion The performed titanium locking plate has a great advantage in the clinic, which can be preferred.