标准化切口与常规切口复位内固定治疗多发肋骨骨折的疗效比较  

Efficacy comparison of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture

作　　者：宋志明 陈检明 钟京 郭军华 余小平 陈松林 蔡伟斌 郑育镇 易云峰 Song Zhiming;Chen Jianming;Zhong Jing;Guo Junhua;Yu Xiaoping;Chen Songlin;Cai Weibin;ZhengYuzhen;Yi Yunfeng(Department of Cardiothoracic Surgery,909th Hospital of Joint Logistics Support Force(Affiliated Dongnan Hospital of Xianmen University Medical College),Cardiothoracic Surgery Medical Center of Eastern War Zone,Zhangzhou 363000,China)

机构地区：[1]联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)心胸外科,东部战区心胸外科医学中心,漳州363000

出　　处：《中华创伤杂志》2022年第11期977-984,共8页Chinese Journal of Trauma

基　　金：军队后勤科研项目(CNJ14C007,CWH17J030);军队高层次科技创新人才工程人选自主科研项目(联战(2022)151)。

摘　　要：目的比较标准化切口与常规切口复位内固定治疗多发肋骨骨折的疗效。方法采用回顾性队列研究分析2020年1月至2022年1月联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)收治的192例多发肋骨骨折患者临床资料,其中男101例,女91例;年龄32~94岁[(51.5±16.6)岁]。患者均接受切开复位镍钛形状记忆合金环抱器肋骨骨折内固定术。96例采用腋前线纵切口等标准化切口(标准化切口组),96例采用后外侧切口等常规切口(常规切口组)。比较两组切口长度、手术时间、术中出血量、固定骨折处数、胸腔闭式引流管留置时间、术后胸腔总引流量、术后自主下床时间、住院时间;术后1个月疼痛视觉模拟评分(VAS);术后并发症发生情况。结果患者均获随访1~16个月[4.0(3.0,10.5)个月]。标准化切口组切口长度为(12.1±1.6)cm,手术时间为(51.4±13.0)min,术中出血量为(191.5±16.8)ml,胸腔闭式引流管留置时间为(2.8±0.6)d,术后胸腔总引流量为(568.9±109.0)ml,术后自主下床时间为(4.1±0.7)d,住院时间为(11.4±1.7)d,术后1个月VAS为(2.5±0.7)分,显著短于或少于常规切口组的(13.7±1.9)cm、(62.0±8.8)min、(248.9±65.4)ml、(4.8±1.1)d、(655.9±121.9)ml、(5.2±0.9)d、(15.3±1.7)d、(3.5±0.7)分(P<0.05或0.01)。标准切口组固定骨折处数为(5.1±0.8)个,常规切口组为(5.4±0.9)个(P>0.05)。标准化切口组切口愈合不良3例,肺部感染5例,肺不张3例,少量胸腔积液3例;常规切口组切口愈合不良11例,肺部感染9例,肺不张7例,少量胸腔积液7例。标准切口组术后并发症发生率为14.6%(14/96),常规切口组为35.4%(34/96)(P<0.01)。结论对于多发肋骨骨折,标准化切口较常规切口复位内固定治疗可显著缩短切口长度、手术时间、引流管留置时间、术后自主下床时间和住院时间,减少术中出血量和术后胸腔总引流量,并减轻术后疼痛,减少术后并发症。Objective:To compare the efficacy of standardized incision and conventional incision for reduction and internal fixation of multiple rib fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 192 patients with multiple rib fracture treated in 909th Hospital of Joint Logistics Support Force(Affiliated Dongnan Hospital of Xianmen University Medical College)from January 2020 to January 2022.There were 101 males and 91 females;aged 32-94 years[(51.5±16.6)years].The patients underwent open reduction and internal fixation with nickel-titanium shape memory alloy embracer via standard incision such as anterior axillary longitudinal incision(standard incision group,n=96)or conventional incision such as posterolateral incision(conventional incision group,n=96).The incision length,operation time,intraoperative blood loss,number of fixed fractures,indwelling time of closed thoracic drainage tube,postoperative thoracic drainage volume,postoperative spontaneous ambulation time and length of hospital stay were compared in the two groups.The visual analogue scale(VAS)was used to evaluate pain at 1 month after operation.Postoperative complications were recorded.Results:All patients were followed up for 1-16 months[4.0(3.0,10.5)months].The operation time,intraoperative blood loss,indwelling time of closed thoracic drainage tube,postoperative thoracic drainage volume,postoperative spontaneous ambulation time,length of hospital stay and VAS at postoperative 1 month in standard incision group[(12.1±1.6)cm,(51.4±13.0)minutes,(191.5±16.8)ml,(2.8±0.6)days,(568.9±109.0)ml,(4.1±0.7)days,(11.4±1.7)days,(2.5±0.7)points]were better than those in conventional incision group[(13.7±1.9)cm,(62.0±8.8)minutes,(248.9±65.4)ml,(4.8±1.1)days,(655.9±121.9)ml,(5.2±0.9)days,(15.3±1.7)days,(3.5±0.7)points](P<0.05 or 0.01).There was no statistical difference in the number of fixed fractures between standard incision group and conventional incision group(5.1±0.8 vs.5.4±0.9)(P>0.05).In standard incision

关 键 词：肋骨骨折 骨折固定术 内 切口入路 

分 类 号：R687.3[医药卫生—骨科学]