预成型肋骨锁定钛板联合超声引导下胸椎旁神经阻滞治疗老年多发性肋骨骨折  

Combined use of prefabricated rib-locking titanium plate with ultrasound-guided thoracic paravertebral nerve blockade in the treatment of multiple rib fractures among the elderly

作　　者：桑宏阳 邬松 范正洋 李谦平[1] 成少飞[1] 范坤 SANG Hong-yang;WU Song;FAN Zheng-yang;LI Qian-ping;CHENG Shao-fei;FAN Kun(不详;Department of Cardiothoracic Surgery,the Affiliated to Shanghai Jiaotong University,Shanghai 201306,China)

机构地区：[1]上海交通大学附属第六人民医院心胸外科,上海201306 [2]上海交通大学附属第六人民医院麻醉科,上海201306

出　　处：《中国骨伤》2022年第10期979-983,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨预成型肋骨锁定钛板内固定手术与超声引导下胸椎旁神经阻滞联合应用对于老年多发性肋骨骨折患者的疗效。方法:回顾性分析2016年2月至2020年11月收治的221例老年多发性肋骨骨折患者,根据是否手术治疗,分为预成型肋骨锁定钛板联合超声引导下胸椎旁神经阻滞组(手术组)102例,保守治疗组(非手术组)119例。手术组中男58例,女44例;年龄60~85(67.2±3.6)岁;肋骨骨折3~12(5.3±2.1)处。非手术组中男66例,女53例;年龄60~84(66.8±3.2)岁;肋骨骨折2~11(6.1±2.3)处。比较分析两组患者的临床资料、治疗效果及并发症情况。结果:两组患者术前临床资料比较,差异无统计学意义(P>0.05),所有患者顺利出院。手术组患者肺部感染(P=0.028),肺不张(P=0.032),呼吸衰竭(P=0.026),主动下床时间(P=0.040),骨折愈合时间(P=0.035),住院时间(P=0.043),治疗后3 d疼痛视觉模拟评分(visual analogue scale,VAS)(P=0.028),治疗后5 d VAS(P=0.032),治疗后7 d VAS(P=0.019),术后3个月最大自主通气量(maximal voluntary ventilation,MVV)(P=0.042),1 s用力呼气容积(forced expiratory volume in one second,FEV1)(P=0.035)以及术后6个月MVV(P=0.021),FEV1(P=0.026)均优于非手术治疗组。结论:对于老年严重多发肋骨骨折的患者,预成型肋骨锁定钛板与超声引导下胸椎旁神经阻滞的联合应用与非手术治疗相比较,能够及时有效镇痛,恢复胸廓稳定性,缩短住院时间,减少肺部感染及急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)等并发症的发生率。预成型肋骨锁定钛板治疗老年多发性肋骨骨折具有较好的临床效果。Objective:This paper is aimed at investigating the efficacy of combining internal fixation using prefabricated rib-locking titanium plate with ultrasound-guided thoracic paravertebral nerve blockade in treating multiple rib fractures among the elderly.Methods:Retrospective analysis of 221 elderly patients with multiple rib fractures treated from February 2016 to November 2020.According to whether surgery was performed,they were divided into the plate-blockage combination group(surgical group,102 cases)and conservative treatment group(non-surgical group,119 cases).The surgical group consisted of 58 males and 44 females aged from 60 to 85 years old,with an average of(67.2±3.6)years old,who suffered from 3 to 12 rib fractures with an average of(5.3±2.1)fractures.The non-surgical group consisted of 66 males and 53 females aged from 60 to 84 years old with an average of(66.8±3.2)years old,who suffered from 2 to 11 rib fractures with an average of(6.1±2.3)fractures.The clinical data,efficacies observed,and complications associated with both groups were compared and analyzed.Results:There was no significant difference in preoperative clinical data between two groups(P>0.05),and all patients were discharged smoothly.Pulmonary infection(P=0.028),atelectasis(P=0.032),respiratory failure(P=0.026),time to get out of bed(P=0.040),time to fracture healing(P=0.035),length of hospital stay in the operation group(P=0.043),visual analogue scale(VAS)at 3 days(P=0.028),5 days(P=0.032),and 7 days(P=0.019),maximal voluntary ventilation(MVV)at 3 months after surgery(P=0.042),forced expiratory volume in one second(FEV1)(P=0.035),and maximal voluntary ventilation at 6 months,the maximal voluntary ventilation(MVV)(P=0.021)and forced FEV1(P=0.026)were all significantly better than those in non-surgical treatment group.Conclusion:For elderly patients with severe multiple rib fractures,the proposed plateblockade combination can timely and effectively relieve pain,restore thoracic stability,shorten hospital stay,and reduce the incidence o

关 键 词：肋骨骨折 锁定钛板 超声 胸椎旁神经阻滞 老年人 

分 类 号：R683.1[医药卫生—骨科学]