纯钛肋骨接骨板内固定治疗肋骨骨折:与保守治疗的疼痛对照分析  

Pure titanium rib plate fixation treats rib facture: pain analysis compared with conservative treatment

作　　者：王作培 谢鑫杰 盛波[1] 丁一[1] 陆熠[1] 程萌旗[2] Wang Zuopei;Xie Xinjie;Sheng Bo;Ding Yi;Lu Yi;Cheng Mengqi(Department of Thoracic Surgery,Shanghai Pudong New District People’s Hospital,Shanghai 201299,China;Shanghai Sixth People’s Hospital,Shanghai 201200,China)

机构地区：[1]上海市浦东新区人民医院胸外科,上海市201299 [2]上海市第六人民医院,上海市201200

出　　处：《中国组织工程研究》2019年第22期3512-3517,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:大量数据表明,手术复位内固定相较保守治疗更具优势。遗憾的是,由于许多临床医生对肋骨骨折治疗的最新理念了解不足,再加上目前尚缺乏高级别临床证据,导致手术在肋骨骨折治疗中的作用还存在诸多争议。目的:探讨纯钛肋骨接骨板在肋骨骨折内固定中对疼痛的治疗效果。方法:选取多发肋骨骨折患者共187例,根据手术与否分为2组,手术组79例,对照组108例进行保守治疗。手术组在双腔气管插管静脉复合麻醉下行胸腔镜辅助多点小切口或直接单切口开放纯钛肋骨接骨板内固定术,手术均在伤后1周内完成,其中伤后3 d内完成者68例,占86%,伤后3-7 d内完成者11例,占14%。收集2组骨折根数、处数、是否伴发血气胸以及是否放置胸管;手术组收集术前1 d、术后第1天、第2天的疼痛评分,对照组收集伤后第1天、第2天疼痛评分。2组指标进行统计学对比分析。结果与结论:①2组均无死亡患者。手术组2例出现术后切口感染,长期换药后发现窦道与接骨板相通,分别于术后34 d及42 d取出接骨板,伤口愈合。其余患者均顺利出院或胸部情况稳定后继续其他外伤治疗;②手术组79例患者骨折根数468根,平均(5.92±2.17)根;骨折处数547处,平均(6.92±2.91)处。非手术组108例患者骨折根数373根,平均(3.45±1.38)根;骨折处数382处,平均(3.54±1.54)处。2组骨折根数与骨折处数比较,差异有显著性意义(P均<0.01);③所有对照组患者疼痛评分908个,疼痛评分2.86±0.36;所有手术组患者术后疼痛评分400个,疼痛评分2.13±0.41,差异有显著性意义(P<0.01),说明手术组患者疼痛较非手术组明显减轻;④2组单日疼痛评分比较,手术组低于对照组(P<0.05);手术组患者术后第1天疼痛评分高于术后第2天,差异有显著性意义(P<0.01);⑤结果表明,伤后1周以内应用纯钛肋骨接骨板内固定治疗肋骨骨折具有减轻疼痛的效果。BACKGROUND:Existing studies have shown that open reduction and internal fixation is superior to the conservative treatment.However,due to the poor understanding of new concept of rib fracture and lack of high-quality evidence,the application in the treatment of rib fracture remains controversial.OBJECTIVE:To investigate the effect of titanium rib plate fixation in the treatment of rib fracture on pain relief.METHODS:One hundred and eighty-seven cases of rib fractures were selected,and then allocated into surgical(n=79)and conservative(n=108)groups.The surgical group was given thoracoscopy-assisted small incision or traditional incision pure titanium rib plate fixation under anesthesia with double lumen tube and artery and central vein catheterized.All surgeries were completed within 1 week after trauma,68 cases completed within 3 days(86%),and 11 cases were completed within 3-7 days(14%).The number and parts of rib fractures,hemopneumothorax and chest tube placement were recorded.The pain scores in the surgical(preoperative 1 day,postoperative 1 and 2 days)and conservative(1 and 2 days post-injury)groups were detected and compared.RESULTS AND CONCLUSION:(1)No case died in both groups.There were two cases of incision infection in the surgical group,and the sinus canal communicated with the plate after long-term dressing.The plate was removed at postoperative 34 and 42 days,and the wound was healed.The remaining patients discharged successfully or underwent other trauma treatment.(2)There were 468(5.92±2.17 mean)fractured ribs in the surgical group,and 382 fractured parts(6.92±2.91 mean).There were 373(3.45±1.38 mean)fractured ribs in the conservative group,and 382 fractured parts(3.54±1.54 mean).There was significant difference in the number and parts of rib fracture between two groups(both P<0.01).(3)The pain score showed significant difference between conservative(908,2.86±0.36)and surgical(400,2.13±0.41)groups(P<0.01),suggesting that the pain was significantly alleviated in the surgical group compared wit

关 键 词：肋骨骨折 纯钛 肋骨接骨板 疼痛 内固定 保守治疗 切口感染 

分 类 号：R459.9[医药卫生—治疗学]