【摘要】 目的 探讨全胸腔镜(VATS)下TiNi环抱式接骨器内固定术(VATS组)、微创钢板内固定(MIPO)应用预成型肋骨锁定钛板(MatrixRIB)内固定术(MIPO组)及全胸腔镜下应用TiNi环抱式接骨器联合MIPO应用MatrixRIB内固定术(VATS+MIPO组)在多发肋骨骨折中的临床疗效。方法 回顾性分析2020年3月至2023年4月因多根多处肋骨骨折行微创内固定手术且符合研究条件的患者共45例，按微创手术方式的不同分为3组：全胸腔镜下TiNi环抱式接骨器内固定手术26例(VATS组);MIPO应用MatrixRIB内固定手术9例(MIPO组);全胸腔镜下TiNi环抱式接骨器联合MIPO应用MatrixRIB内固定手术10例(VATS+MIPO组)。统计分析3组患者的术前一般资料、术中资料、治疗指标及并发症。结果 3组入院时VAS疼痛评分差异无统计学意义(P>0.05);3组手术时间比较差异无统计学意义(P>0.05);3组术后3 d疼痛评分、术后7 d疼痛评分比较，差异无统计学意义(P>0.05);3组术中出血量、住院时间差异无统计学意义(P>0.05);MIPO组引流管拔除时间最短，差异有统计学意义(P<0.001),MIPO组术后并发症发生率较低，差异有统计学意义(P<0.05)。结论 3种微创肋骨骨折内固定术各有其优势及适应证。VATS可通过小切口全面探查胸腔，可同期处理肺裂伤、肺大疱等疾病。MIPO应用MatrixRIB使骨折断端之间软组织的完整性得到了很好的保护，具有切口小、术后拔管时间短、并发症低等优势；全胸腔镜下TiNi环抱式接骨器联合MatrixRIB内固定手术特别适用于多段复杂肋骨骨折的治疗，具有手术切口少、术中无需变换体位等优势。更多还原

【Abstract】 Objective To explore internal fixation of TiNi embracing fixator under total video-assisted thoracoscopy(VATS group).Clinical efficacy of minimally invasive plate osteosynsis(MIPO) using preformed rib locking titanium plate(MatrixRIB) internal fixation(MIPO group) and video assisted thoracocopy(VATS) using TiNi embracing fixator combined with MIPO using preformed rib locking titanium plate(MatrixRIB) internal fixation(VATS+MIPO group) in multiple rib fractures.Methods From March 2020 to April 2023,a retrospective analysis was conducted on total 45 patients who underwent minimally invasive internal fixation surgery for multiple rib fractures and met the research criteria.According to different minimally invasive surgical methods, they were divided into three groups: 26 patients underwent total thoracoscopic TiNi embracing fixator internal fixation surgery(VATS group),9 cases(MIPO group) underwent internal fixation surgery with pre formed rib locking titanium plate(MatrixRIB) using MIPO,10 patients(VATS+MIPO group) underwent internal fixation surgery using a pre formed rib locking titanium plate(MatrixRIB) using a TiNi embracing bone connector combined with MIPO under total thoracoscopy.Statistical analysis of preoperative general data, intraoperative data, treatment indicators, and complications.Results There was no statistically significant difference in VAS pain scores among the three groups at admission(P>0.05).There was no statistically significant difference in surgical time among three groups(P>0.05).There was no statistically significant difference in postoperative pain scores at 3 days and 7 days among three groups(P>0.05).There was no statistically significant difference in intraoperative bleeding volume and hospital stay among three groups(P>0.05).The MIPO group had the shortest time to remove the thoracic catheter(P<0.001),and MIPO group had a lower incidence of postoperative complications(P<0.05).Conclusion Three minimally invasive internal fixation procedures for rib fractures each had their own advantages and indications.Full thoracoscopy could comprehensively explore the chest through small incisions, and could simultaneously treat diseases such as lung lacerations and pulmonary bullae.It is particularly suitable to treat multiple rib fractures in the posterior rib and scapula.MIPO’s application of preformed rib locking titanium plate(MatrixRIB) provides excellent protection for the integrity of soft tissue between fracture ends, with advantages such as small incision, short postoperative extubation time, and low complications.It is suitable for various rib fractures without thoracoscopic exploration pointers.The combination of TiNi embracing fixator and pre-formed rib locking titanium plate(MatrixRIB) internal fixation surgery under thoracoscopy is particularly suitable for the treatment of multiple complex rib fractures, such as the treatment of dorsal rib fractures combined with axillary and anterior rib fractures.A single small incision could be used for fixation of axillary and anterior fractures, as well as for endoscopic exploration and treatment of posterior and dorsal fractures.It has advantages of fewer surgical incisions and no need to change positions during surgery.更多还原