内固定手术治疗多发性肋骨骨折的疗效与安全性的随机对照试验  

Effi cacy and Safety of Internal Rib Fixation for Multiple Rib Fractures: A Randomized Controlled Trial

作　　者：王立[1] 古丽尼格尔.吐尔逊 康迪[1] 伊力哈木[1] 杜萍[1] 

机构地区：[1]新疆医科大学第六附属医院胸外科,乌鲁木齐830002

出　　处：《中国胸心血管外科临床杂志》2014年第2期228-232,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：新疆医科大学2012年科研创新基金(XJC2012145)~~

摘　　要：目的 探讨肋骨内固定手术对多发性肋骨骨折患者的疗效与安全性。 方法 新疆医科大学第六附属医院胸外科2010年1月至2013年1月收治的多发性肋骨骨折患者，选取胸部创伤评分（AIS-ISS评分） 9～20 （16±2）分的患者141例，采用SPSS软件产生的随机序号将患者分为内固定组［69例，男41例、女28例，年龄25～61 （37±4）岁］ 和对照组［72例，男43例、女29例，年龄24～63 （35±5）岁］，分别行肋骨内固定手术和保守治疗。观察患者血浆C反应蛋白（CRP）水平变化、胸廓外观满意度、肺部炎症发生率、止痛有效率，以及闭式引流时间和住院时间。结果 内固定组CRP水平在伤后1～3 d与对照组差异无统计学意义（P＞0.05），在伤后4～12 d内明显低于对照组（P＜0.05）。内固定组胸廓外观满意度（97.1% vs. 48.6%，P＜0.05）、肺部炎症发生率（11.6% vs. 37.5%，P＜0.01）和止痛有效率（91.3% vs. 68.1%， P＜0.05）均优于对照组，胸腔闭式引流时间［（3±2） d vs. （7±4） d，P＜0.05］和住院时间［（9±4） d vs. （15±7） d，P＜0.05］均短于对照组。 结论 对多发性肋骨骨折患者，在生命体征平稳的前提下，采用肋骨内固定手术有利于缩短住院时间和缓解胸痛程度，胸廓外观明显改善，从减轻肺部炎症反应和增加手术安全性的角度提高了多发性肋骨骨折的治疗效果。Objective To investigate the efficacy and safety of internal rib fixation for patients with multiple rib fractures. Methods A total of 141 patients with multiple rib fractures who were admitted to Department of Thoracic Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2010 and January 2013 and whose chest trauma score （AIS-ISS） was 9-20 （16±2） were recruited in this study. Using the random number generator of SPSS, all the patients were randomly divided into an internal fixation group [69 patients including 41 males and 28 females with their age of 25-61 （37±4） years] who underwent internal rib fixation, and a control group [72 patients including 43 males and 29 females with their age of 24-63 （35±5） years] who received conservative therapy. Plasma C-reactive protein （CRP）,patients’ satisfaction degree with thoracic appearance,incidence of lung infection,pain-relieving efficacy,postoperative chest drainage duration and length of hospital stay were compared between the 2 groups. Results Plasma CRP levels of theinternal fixation group were not statistically different from those of the control group in 1-3 days after injury （P〉0.05）,but were significantly lower than those of the control group in 4-12 days after injury （P〈0.05）. Patients’ satisfaction degreewith thoracic appearance （97.1% vs. 48.6%,P〈0.05）and pain-relieving efficiency （91.3% vs. 68.1%,P〈0.05） of the internal fixation group were significantly higher than those of the control group. Incidence of lung infection of the internal fixation group was significantly lower than that of the control group（11.6% vs. 37.5%,P〈0.01）. Postoperative chest drainage duration [（3±2） d vs. （7±4） d,P〈0.05] and length of hospital stay [（9±4） d vs. （15±7） d,P〈0.05] of the internal fixation group were significantly shorter than those of the control group. Conclusions For patients with multiple rib fractures and stable vital signs,internal fixation surgery is

关 键 词：多发性肋骨骨折 内固定手术 C反应蛋白 疗效 安全性 

分 类 号：R687.3[医药卫生—骨科学]