胸腔镜手术内固定与传统剖胸内固定治疗多发肋骨骨折的疗效比较  

Comparison of video-assisted thoracoscopic surgery and traditional thoracotomy for treatment of multiple rib fractures

作　　者：任明明[1] 孔繁义[1] 杨博[1] 袁君[1] 孟庆军[1] 周文艳[1] 

机构地区：[1]沧州市中心医院胸外科,061001

出　　处：《中华创伤杂志》2014年第6期512-515,共4页Chinese Journal of Trauma

摘　　要：目的比较胸腔镜手术内固定与传统剖胸内固定治疗创伤性多发肋骨骨折的效果。方法回顾性分析2005年7月-2012年9月收治的56例创伤性多发肋骨骨折内固定手术患者的临床资料。根据治疗方法分为胸腔镜手术内固定组（胸腔镜组，27例）和传统剖胸内固定组（剖胸组，29例）。比较两组手术时间、术中出血量、呼吸机通气支持率、机械通气时间、ICU住院时间、肺感染发生率、伤后3d视觉模拟评分（visual analogue seale，VAS）、死亡率等。结果与剖胸组比较，胸腔镜组手术时间[（128．9±21．1）min：（140．7±24．2）min]、呼吸机通气支持率（70％：76％）及死亡率（4％：7％）差异无统计学意义（P〉0．05），术中出血量[（321．1±30．1）ml：（438．1±43．2）ml]减少（P〈0．01），机械通气时间[（4．3±2．1）d：（7．2±1．6）d]缩短（P〈0．01），ICU住院时间[（5．9±21．1）d：（8．5±1．7）d]缩短（P〈0．01），肺感染发生率（33％：90％）减低（P〈0．01），VAS[（7．0±1．4）分：（8．3±0．9）分]下降（P〈0．01）。结论胸腔镜手术内固定治疗创伤性多发肋骨骨折具有术中出血少、术后机械通气及ICU住院时间短、肺感染率低等优点，疗效优于传统剖胸内固定。Objective To compare the therapeutic effect of video-assisted thoracoscopic surgery and traditional thoracotomy in fixation of traumatic multiple rib fractures. Methods Clinical data of 56 patients with traumatic multiple rib fractures treated surgically between July 2005 and September 2012 were analyzed retrospectively. Based on the treatments, the patients were assigned to video-assisted thoracoscopy group （ thoraeoscopy group, n = 27 ） and traditional thoracotomy group （ thoracotomy group, n = 29 ）. A comparison was done on the variables including operation time, intraoperative blood loss, ventilator support rate, duration of mechanical ventilation, length of ICU stay, incidence of lung infections, visual analogue scale （VAS） at day 3 postinjury and mortality between the two groups. Results Operation time [ （ 128.9 ± 21.1 ） min vs （ 140.7 ±24.2 ） min ], ventilator support rate （ 70% vs 76% ） and mortality （4% vs 7% ） in thoracoseopy group revealed no statistical differences compared with thoraeoto- my group （ P 〉 0.05 ） , but iutraoperative blood loss [ （ 321.1 ± 30.1 ） ml vs （438.1 ± 43.2） ml ], duration of mechanical ventilation [ （4.3 ± 2.1 ） d vs （ 7.2 ± 1.6 ） d ], length of ICU stay [ （ 5.9 ± 21.1 ） d vs （ 8.5 ± 1.7） d ] , incidence of lung infection （ 33 % vs 90% ）, and VAS [ （7.0 ± 1.4 ） points vs （ 8.3 ± 0.9） points] were significantly reduced in thoracoscopy group than in thoracotomy group （all P 〈 0.01 ）. Conclusion Video-assisted thoracoscopic surgery is characterized by fewer intraoperative bleeding, shorter duration of mechanical ventilation and ICU stay, and lower lung infection rate during treatment of trau- matic multiple rib fractures compared to traditional thoracotomy.

关 键 词：肋骨骨折 胸腔镜 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]