中国骨伤2025，Vol.38Issue(1)：47-54,8.DOI:10.12200/j.issn.1003-0034.20230319
胸腔镜微创手术治疗多发肋骨骨折并连枷胸的临床效果
Thoracoscopic minimally invasive surgery for the treatment of flail chest with multiple rib fractures
摘要
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,in-cluding 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 in-flammatory 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-1vs(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·ml1 in both groups exhibited an increase post-treatment,while the C-re-active protein(CRP)(75.51±10.54)mg·L-1 vs(60.75±9.84)mg·L-1 demonstrated a decrease compared to pre-treatment lev-els.Furthermore,the study group displayed significantly lower levels than the control group(P＜0.05).After 10 days of treat-ment,the peak expiratory flow rate(3.31±0.52)L·s-1vs(5.69±0.74)L·s-1,forced expiratory volume(1.46±0.29)Lvs(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 com-pared 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 bet-ter therapeutic effect,because of less surgical trauma,less pain and inflammatory reaction,fewer postoperative pulmonary com-plications,faster and better recovery of lung function,and thus promote the recovery of patients.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Key words
Thoracoscopic minimally invasive surgery/Rib-preserving periosteal fixation/Multiple rib fractures/Flail chest分类
医药卫生引用本文复制引用
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):47-54,8.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)Hubei Province Key Laboratory of Occupational Hazard Identification and Control,Wuhan University of Science and Technolo-gy(No.JF2023-G02) （编号:JF2023-G02）
