胸腔镜联合穿刺定位内固定治疗多发肋骨骨折合并血气胸的疗效  

Effect of thoracoscopy combined with puncture-positioned internal fixation of multiple rib fractures accompanied with hemopneumothorax

作　　者：陈前顺[1] 黄郴[1] 赵力澜 林兴[1] 徐驯宇[1] 谢莉[1] Chen Qianshun;Huang Chen;Zhao Lilan;Lin Xing;Xu Xunyu;Xie Li(Department of Thoracic Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院胸外科,福州350001

出　　处：《中华创伤杂志》2020年第7期614-618,共5页Chinese Journal of Trauma

摘　　要：目的探讨胸腔镜联合穿刺定位内固定治疗多发肋骨骨折合并血气胸的临床疗效。方法采用回顾性病例对照研究分析2016年9月—2018年12月福建省立医院收治的68例多发肋骨骨折合并血气胸患者临床资料,其中男49例,女19例;年龄25~86岁[(47.3±7.4)岁]。单侧肺挫裂伤55例,双侧肺挫裂伤13例。36例行胸腔镜联合穿刺定位内固定治疗(胸腔镜组),32例行传统切开复位内固定治疗(切开复位组)。比较两组切口长度、手术时间、术中出血量、胸管引流时间、ICU住院时间、总住院时间及并发症发生率。比较术后1,2,3,7 d疼痛数字评分量表(NRS)评分及末次随访时患者健康状况调查量表(SF-36)评分。结果患者均获随访8~34个月[(18.9±4.3)个月]。胸腔镜组切口长度[(4.3±1.3)cm]、手术时间[(66.3±12.1)min]、术中出血量[(86.5±23.4)ml]、胸管引流时间[(5.3±1.1)d]、ICU住院时间[(2.3±0.8)d]、总住院时间[(6.8±1.7)d]及总并发症发生率(8%)均优于切开复位组[分别为(11.6±2.2)cm、(105.9±19.4)min、(191.4±35.6)ml、(8.1±1.6)d、(4.7±1.4)d、(10.6±2.1)d、29%](P<0.05或0.01)。胸腔镜组术后1,2,3,7 d的NRS评分分别为(6.6±1.2)分、(5.9±1.0)分、(4.4±0.9)分、(2.7±0.7)分,显著低于切开复位组的(7.3±1.2)分、(7.0±1.1)分、(5.7±1.0)分、(3.9±0.8)分(P<0.05或0.01)。末次随访时,胸腔镜组SF-36评分为(86.4±12.1)分,显著高于切开复位组的(75.6±11.5)分(P<0.01)。结论与切开复位内固定比较,胸腔镜联合穿刺定位内固定治疗多发肋骨骨折具有切口小、手术时间短、术中出血少、胸管引流时间短、ICU住院时间短、总住院时间短及术后并发症少等优势,同时可减轻术后疼痛,提高患者的生活质量。Objective To investigate the clinical effect of thoracoscopy combined with puncture-positioned internal fixation of multiple rib fractures accompanied with hemopneumothorax.Methods A retrospective case-control study was used to analyze the clinical data of 68 patients with multiple rib fractures accompanied with hemopneumothorax admitted to Fujian Provincial Hospital from September 2016 to December 2018,including 49 males and 19 females,aged 25-86 years[(47.3±7.4)years].There were 55 patients with unilateral lung contusion and laceration,and rest 13 patients with bilateral lung contusion and laceration.A total of 36 patients were treated by thoracoscopy combined with puncture-positioned internal fixation(thoracoscopy group)and 32 patients by open reduction group(open reduction group).The incision length,operation time,intraoperative blood loss,chest tube drainage time,ICU hospitalization time,total hospitalization time,and complications were recorded.Numeric rating scale(NRS)score was assessed at postoperative 1,2,3,7 days.The MOS 36-item short-form health survey(SF-36)was conducted at the latest follow-up.Results All patients were followed up for 8-34 months[(18.9±4.3)months].Thoracoscopy group showed incision length of(4.3±1.3)cm,operation time of(66.3±12.1)minutes,intraoperative blood loss of(86.5±23.4)ml,chest tube drainage time of(5.3±1.1)days,ICU hospital stay of(2.3±0.8)days,total hospital stay of(6.8±1.7)days,and total complication rate of 8%,showing significant differences compared to open reduction group[(11.6±2.2)cm,(105.9±19.4)minutes,(191.4±35.6)ml,(8.1±1.6)days,(4.7±1.4)days,(10.6±2.1)days,29%](P<0.05 or 0.01).In thoracoscopy group,the NRS scores at day 1,2,3,and 7 were respective(6.6±1.2)points,(5.9±1.0)points,(4.4±0.9)points and(2.7±0.7)points,significantly lower than those in open reduction group[(7.3±1.2)points,(7.0±1.1)points,(5.7±1.0)points and(3.9±0.8)points](P<0.05 or 0.01).The SF-36 score in thoracoscopy group was(86.4±12.1)points,significantly higher than that in ope

关 键 词：肋骨骨折 血气胸 胸腔镜检查 穿刺术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]