【摘要】 目的研究胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗多发性肋骨骨折(fracture of multiple ribs,FMR)的临床效果。方法 2013年1月—2017年6月河南省人民医院收治的FMR患者136例,其中男性88例,女性48例;年龄24~79岁,平均43.38岁。致伤因素:道路交通伤82例,高处坠落伤34例,砸伤20例。依据随机数字表法分为实验组(n=68)与对照组(n=68),实验组行胸腔镜下形状记忆肋骨环抱接骨板内固定治疗,对照组行开胸形状记忆肋骨环抱接骨板内固定治疗。观察两组术中出血量、手术时间、术后呼吸机时间、引流管放置时间、住院时间,两组术前、术后7d白介素-6(IL-6)、白介素-8(IL-8)、C-反应蛋白(CRP)等炎性因子水平及肺活量,两组术前、术后1、3、5、7d疼痛评分,术后肺不张、肺炎发生情况。结果实验组术中出血量、手术时间、术后呼吸机时间、引流管放置时间、住院时间分别为(189.76±19.53)m L、(58.97±5.92)min、(1.97±0.21)d、(2.33±0.24)d、(7.92±0.83)d,均低于对照组的(221.68±22.65)m L、(80.76±8.18)min、(3.69±0.38)d、(4.79±0.49)d、(13.19±1.33)d,P<0.05。术后7d,实验组IL-6、IL-8、CRP分别为(90.85±9.11)ng/L、(112.86±11.21)ng/L、(4.74±0.48c)mg/L,均低于对照组的(136.57±13.62)ng/L、(228.42±22.49)ng/L、(6.64±0.68)mg/L,肺活量(2116.76±213.65)m L高于对照组(1789.95±181.75)m L(P<0.05)。术后1、3、5、7d,实验组疼痛评分(疼痛强度数字评分法评价)均低于对照组(P<0.05)。实验组术后肺不张、肺炎发生率(4.41%、7.35%)低于对照组(14.71%、20.59%),P<0.05。结论胸腔镜辅助下形状记忆肋骨环抱接骨板内固定治疗FMR创伤小,固定牢固,术后恢复快,值得临床应用。更多还原

【Abstract】 Objective To study the clinical effect of thoracoscopic nickel-titanium shape memory alloys internal fixation in treating fracture of multiple ribs(FMR). Methods A total of 136 FMR patients were admitted to our hospital from Jan. 2013 to Jun. 2017. Among them were 88 male cases and 48 female cases with an average age of 43. 38(24-79) years. The injured factors included traffic injury in 82 cases,high fall injury in 34 cases,and crashing injury in 20 cases. They were selected and divided into experimental group(n = 68) and control group(n =68) using the random number table method. Patients in experimental group were performed thoracoscopic nickel-titanium shape memory alloys internal fixation,and those in control group were performed transthoracic nickel-titanium internal fixation. The intraoperative blood loss,operation time,postoperative ventilation time,drainage tube placement time,hospital stays,the level of inflammatory factors such as IL-6,IL-8 and CRP and vital capacity before operation and 7 d after operation,the pain score before operation and 1 d,3 d,5 d and 7 d after operation,the postoperative pulmonary atelectasis and the incidence of pneumonia of the two groups were observed. Results The intraoperative blood loss,operation time,postoperative ventilation time,drainage tube placement time,hospital stays in the experimental group were less than those in the control group(189. 76 ± 19. 53) m L vs.(221. 68 ± 22. 65) m L,(58. 97 ±5. 92) min vs.(80. 76 ± 8. 18) min,(1. 97 ± 0. 21) d vs.(3. 69 ± 0. 38) d,(2. 33 ± 0. 24) d vs.(4. 79 ± 0. 49) d,(7. 92 ± 0. 83) d vs.(13. 19 ± 1. 33),P < 0. 05). At 7 d after operation,the levels of IL-6,IL-8 and CRP in the experimental group were lower than those in the control group(90. 85 ± 9. 11) ng/L vs.(136. 57 ± 13. 62) ng/L,(112. 86 ± 11. 21) ng/L vs.(228. 42 ± 22. 49) ng/L,(4. 74 ± 0. 48 c) mg/L vs.(6. 64 ± 0. 68) mg/L,and the vital capacity was higher than that in control group(2116. 76 ± 213. 65) m L vs.(1789. 95 ± 181. 75) m L,P < 0. 05).At 1 d,3 d,5 d and 7 d after operation,the pain scores in experimental group were lower than those in control group(P < 0. 05). The incidences of postoperative pulmonary atelectasis and pneumonia in experimental group(4. 41%,7. 35%) were lower than those in control group(14. 71%,20. 59%)(P < 0. 05). Conclusion Thoracoscopic nickel-titanium shape memory alloys internal fixation in treating FMR generates less trauma,firm fixation and fast postoperative recovery,so the therapy is worthy of clinical application.更多还原