镍钛形状记忆合金环抱器内固定与胸部护板外固定治疗多发肋骨骨折的疗效对比研究  

Comparative study on efficacy of internal fixation with nitinol shape memory alloy embracing device and external fixation with chest guard plate in the treatment of multiple rib fractures

作　　者：周攀 程玲玲 朱杰 吴中权[1] 舒圣 Zhou Pan;Cheng Lingling;Zhu Jie;Wu Zhongquan;Shu Sheng(Department of Thoracic Surgery,Hanyang Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430050,China)

机构地区：[1]武汉科技大学附属汉阳医院胸外科,武汉430050

出　　处：《创伤外科杂志》2022年第3期209-213,共5页Journal of Traumatic Surgery

基　　金：湖北省卫生和计划生育委员会联合基金(WJ2018H0123)。

摘　　要：目的对比胸部护板外固定和镍钛形状记忆合金环抱器内固定治疗多发肋骨骨折的疗效。方法回顾性分析2018年9月—2020年9月武汉科技大学附属汉阳医院胸外科接受治疗的114例多发肋骨骨折患者临床资料。男性78例,女性36例;年龄26~58岁,平均38.8岁;致伤原因:高处坠落伤28例,暴力击打伤15例,道路交通伤45例,塌方挤压伤9例,跌倒摔伤17例。根据固定方式不同分为外固定组(n=54,胸部护板外固定)和内固定组(n=60,镍钛形状记忆合金环抱器内固定)。观察两组患者恢复指标[骨折愈合时间、出院时间、下床活动时间、视觉模拟评分(VAS)]、肺功能指标[用力肺活量占预计值百分比(FVC%pred)、最大肺通气量(MVV)、第1s用力呼气容积占预计值百分比(FEV_(1)%pred)]、血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、血清疼痛介质[前列腺素E2(PGE2)、P物质(SP)、5-羟色胺(5-HT)、神经肽Y(NPY)]和并发症发生率。结果内固定组的骨折愈合时间、出院时间、下床活动时间短于外固定组,VAS低于外固定组(t=12.610、9.165、9.713、8.828,均P<0.001)。内固定组术后3个月FVC%pred、MVV、FEV_(1)%pred高于外固定组(t=-6.913、-5.533、-8.219,均P<0.001)。内固定组术后3d的PaO_(2)高于外固定组,PaCO_(2)低于外固定组(t=-6.299、13.475,均P<0.001)。内固定组术后3d PGE2、SP、5-HT、NPY低于外固定组(t=8.422、9.507、10.503、16.703,均P<0.001)。内固定组的并发症发生率低于外固定组(χ^(2)=4.321,P=0.028)。结论镍钛形状记忆合金环抱器内固定治疗多发肋骨骨折,可促进患者恢复,有效改善肺功能及血气状况、缓解疼痛,疗效优于胸部护板外固定。Objective To compare the efficacy of external fixation with chest guard plate and internal fixation with nitinol shape memory alloy embracing device in the treatment of multiple rib fractures.Methods The clinical data of 114 patients with multiple rib fractures who were treated in the Department of Thoracic Surgery of Hanyang Hospital Affiliated to Wuhan University of Science and Technology from Sep.2018 to Sep.2020 were retrospectively analyzed.There were 78 males and 36 females;the age ranged from 26 to 58 years,with an average age of 38.8 years;the causes of injury:28 cases of falling from heights,15 cases of violent blow injury,45 cases of road traffic injury,9 cases of collapse crush injury,and 17 cases of fall injury.According to different surgical methods,the patients were divided into external fixation group(n=54,external fixation with chest shield)and internal fixation group(n=60,internal fixation with nitinol shape memory alloy embracing device).The recovery indexes[fracture healing time,discharge time,ambulation time,visual analogue scale(VAS)],pulmonary function indexes[(forced vital capacity percentage of predicted value(FVC%pred),maximum voluntary ventilation(MVV),percentage of forced expiratory volume in 1s(FEV1%pred)],blood gas analysis indicators[arterial partial pressure of oxygen(PaO_(2)),arterial blood carbon dioxide partial pressure(PaCO_(2))],serum pain mediators(prostaglandin E2(PGE2),substance P(SP),5-hydroxytryptamine(5-HT),neuropeptide Y(NPY)]and the incidence of complications were observed in the two groups of patients.Results The fracture healing time,discharge time and out of bed activity time of the internal fixation group were shorter than those in the external fixation group,and VAS was lower than that in the external fixation group(t=12.610,9.165,9.713,8.828,all P<0.001).FVC%pred,MVV and FEV1%pred in the internal fixation group were higher than those in the external fixation group at 3 months after operation(t=-6.913,-5.533,-8.219,all P<0.001).PaO_(2) in the internal fixation grou

关 键 词：肋骨骨折 胸部护板 记忆合金环抱器 内固定 外固定 

分 类 号：R683.1[医药卫生—骨科学]