非连枷胸肋骨骨折手术疗效评估  

Evaluation on the curative effect of surgical treatment of non-flail chest rib fractures

作　　者：李扬 何伟伟[1] 杨异[1] 吴伟铭[1] 高宗礼[1] 赵永红[1] 郭翔 赵天成[1] Li Yang;He Weiwei;Yang Yi;Wu Weiming;Gao Zongli;Zhao Yonghong;Guo Xiang;Zhao Tiancheng(Department of Thoracic Surgery,Shanghai Sixth People's Hospital,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院胸外科,200233

出　　处：《中华胸部外科电子杂志》2019年第1期1-5,共5页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的评估非连枷胸肋骨骨折的手术疗效。方法回顾性性分析上海交通大学附属第六人民医院胸外科2015年5月至2016年6月收治的109例非连枷胸肋骨骨折病例(骨折数≥3根),测定并比较患者入院即刻(IN)、术前1天(PRE)以及术后第1、2和7天(D1、D2、D7)的相应疼痛指数(PAIN)、肺功能指标,即肺活量(VC)、第一秒用力呼气量(FEV_1)、呼气流量峰值(PEF)的差异。结果109例非连枷胸肋骨骨折患者中男性85例(78.0%),女性24例(22.0%);年龄23～74岁(平均年龄52岁);合并多发伤75例(68.8%),单纯胸外伤34例(31.2%);平均损伤严重度评分(ISS)18.21分;平均肋骨骨折数5.79(3～16)根;平均入院至手术时间4.36(1～16)d。术后所有患者获得治愈,术后切口感染2例(1.8%),切口周围麻木5例(4.6%)。肋骨骨折手术治疗后第7天即可明显缓解疼痛,改善肺功能指标(VC、FEV_1和PEF),与术前比较差异均有统计学意义(P<0.05)。结论对于骨折数≥3根的非连枷胸肋骨骨折患者手术治疗早期即可明显缓解疼痛,快速恢复肺功能,手术简单安全。Objective To evaluate the effect of operative treatment of non-flail chest rib fractures.Methods A retrospective analysis of 109 patients who underwent non-flail chest rib fractures between May 2015 and June 2016 was conducted.We compared patients’pain index and pulmonary function parameters(vital capacity,VC;forced vital capacity in the first second,FEV 1;peak expiratory flow,PEF)at different stages:at hospital admission(IN),on the day before surgery(PRE),and on postoperative days one(D1),two(D2),and seven(D7).Results The 109 patients included 85 men(78.0%)and 24 women(22.0%)between the age of 23 and 74(with a mean of 52).75 had multiple injuries(68.8%),34 had chest trauma solely(31.2%),the average injury severity score(ISS)was 18.2.The average number of fractured ribs was 5.8(ranging from 3-16).The average length of time from admission to operative intervention was 4.4 days(ranging from 1-16).The fractures healed in all patients,while superficial wound infections occurred in two cases(1.8%),skin numbness around the incision occurred in 5 cases(4.6%).Pain and pulmonary function parameters(VC,FEV 1,PEF)had improved significantly by postoperative day seven(P<0.05).Conclusions In patients with three or more non-flail chest rib fractures,early surgical treatment is safe,and can effectively relieve pain,leading to rapid recovery of lung function.

关 键 词：非连枷胸肋骨骨折 手术治疗 肺功能 疼痛指数 

分 类 号：R687.3[医药卫生—骨科学]