解剖型肋骨接骨板与可吸收肋骨钉在多发肋骨骨折手术中的疗效比较  

Comparison of the efficacies of anatomical rib plates and absorbable rib nails in multiple rib fracture operation

作　　者：张高 高志[1] ZHANG Gao;GAO Zhi(Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院,北京100050

出　　处：《中国现代医生》2021年第26期67-72,共6页China Modern Doctor

摘　　要：目的 分析多发肋骨骨折患者手术中解剖型肋骨接骨板与可吸收肋骨钉的疗效,为实际应用给予参考。方法 收集2013年6月至2019年5月我院胸外科多发肋骨骨折患者的病例资料,筛选出73例患者进行回顾性分析。34例采用可吸收肋骨钉固定手术治疗,作为对照组;39例采用解剖型肋骨接骨板内固定手术治疗,作为观察组。对两组肺功能、血气指标、VAS评分等进行评价,对两组手术时间、术中出血量、术后引流时间、住院时间、住院费用、术后并发症及术后愈合情况进行统计分析。结果 ①两组术前最大通气量(Maximum ventilatory volume,MVV)、呼气峰流量(Peak expiratory flowrate,PEF)、第1秒用力呼气过程中容积(Forced expiratory volume in one second,FEV1)、最大控制用力提高肺活量(Forced vital capacity,FVC)等比较,差异无统计学意义(P>0.05),术后均较术前有好转,观察组术后的PEF、MVV、FEV1/FVC指标均高于对照组,差异有统计学意义(P<0.05)。②两组术后3 d、7 d PaO2、SaO2较术前均有显著改善(P<0.05),PaCO2较术前均显著下降(P<0.05),且观察组各血气指标均显著好于对照组(P<0.05)。③两组术前VAS评分比较,差异无统计学意义(P>0.05),术后评分均降低(P<0.05),观察组术后的VAS评分低于对照组(P<0.05)。④两组患者术中固定肋骨数量、术后引流持续时间、术后卧床时间、住院时间及住院费用比较,差异无统计学意义(P>0.05),观察组的手术时间、术中出血量相比对照组有显著性减少(P<0.05)。⑤观察组胸部X线复查提示无骨折移位发生,骨性愈合均良好;对照组畸形愈合不良4例(11.76%),观察组无畸形愈合,差异有统计学意义(χ^(2)=4.854,P=0.039)。结论 二者均能改善多发肋骨骨折手术患者呼吸功能、减轻疼痛、促进骨折愈合,且解剖型肋骨接骨板效果更好。解剖型肋骨接骨板更加节省手术时间、减少出血量,但由于其具有二次手术�Objective To analyze the efficacies of anatomical rib plates versus absorbable rib nails in patients undergoing multiple rib fracture operation,so as to provide reference for practical application.Methods The data of patients with multiple rib fractures in the department of thoracic surgery in our hospital from June 2013 to May 2019 were collected,and 73 patients were screened for a retrospective analysis.34 patients treated with absorbable rib nail fixation were selected as the control group,while 39 patients treated with anatomical rib plate internal fixation were selected as the observation group.Pulmonary function,blood gas index,and the scores of Visual Analogue Scale/Score(VAS)were evaluated in both groups.Meanwhile,the operation duration,intraoperative blood loss,duration of postoperative drainage,length of stay,hospitalization cost,postoperative complications,and postoperative healing in both groups were statistically analyzed.Results①There was no statistical differences between the two groups in terms of maximum ventilatory volume(MVV),peak expiratory flowrate(PEF),forced expiratory volume in one second(FEV1),and forced vital capacity(FVC)before operation.After operation,all the above-mentioned indicators were improved than those before operation.The indexes of PEF,MVV,FEV1 and FVC in the observation group were higher than those in the control group after operation,with statistically significant differences(P<0.05).②3 days and 7 days after the operation,the alveolar oxygen partial pressure(PaO2)and arterial oxygen saturation(SaO2)improved significantly(P<0.05)and alveolar partial pressure of carbon dioxide(PaCO2)decreased significantly(P<0.05)compared with those before operation,and all blood gas indexes in the observation group were significantly better than those in the control group(P<0.05).③There was no difference in the VAS scores between the two groups before operation,and the scores decreased in both groups after operation(P<0.05).Meanwhile,the VAS scores in the observation group were signif

关 键 词：可吸收肋骨钉 解剖型肋骨接骨板 多发肋骨骨折 愈合 

分 类 号：R687.3[医药卫生—骨科学]