胸腔镜下三种不同类型肋骨接骨板治疗肋骨骨折的临床疗效探讨  

Clinical Efficacy of Thoracoscopic Three Different Types of Rib Plate in the Treatment of Rib Fracture

作　　者：陈辉[1] 邱明链[2] CHEN Hui;QIU Minglian(Department of Thoracic Surgery,Fuzhou Second Hospital,Fuzhou,Fujian Province,350007 China;Department of Thoracic Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian Province,350004 China)

机构地区：[1]福州市第二医院胸外科,福建福州350007 [2]福建医科大学附属第一医院胸外科,福建福州350004

出　　处：《中外医疗》2022年第31期65-69,共5页China & Foreign Medical Treatment

基　　金：福州市科技计划项目(2021-S-162);福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014)。

摘　　要：目的 探讨胸腔镜下三种不同类型肋骨接骨板治疗肋骨骨折的临床效果。方法 选择2021年6月—2022年6月福州市第二医院收治的多发肋骨骨折行内固定治疗者121例为研究对象。本研究入组者均在全身麻醉双腔气管插管下实施胸腔镜肋骨骨折内固定术治疗,按照使用的内固定材料不同分为3组(镍钛合金组17例、纯钛接骨板组61例和MIPO接骨板组43例)。比较各组手术及术后恢复情况,比较各组治疗前后疼痛评分和C反应蛋白水平变化情况,比较各组干预过程中动脉血气及肺功能异常情况,统计各组术后并发症。结果 MIPO接骨板组术中出血量为(56.8±9.6)mL,术后胸腔引流总量为(45.2±12.7)mL少于纯钛接骨板组和镍钛合金组,差异有统计学意义(F=35.010、26.367,P<0.05),MIPO接骨板组拔除引流管时间和住院时间分别为(2.1±0.5)、(6.2±2.1)d,短于纯钛接骨板组和镍钛合金组,差异有统计学意义(F=7.117,10.748,P<0.05),MIPO接骨板组术后疼痛评分及C反应蛋白水平分别为(2.1±0.3)分和(7.2±1.2)mg/L,低于纯钛接骨板组和镍钛合金组,差异有统计学意义(F=7.538、12.451,P<0.05),MIPO接骨板组干预过程中发生低氧血症、过度通气、二氧化碳蓄积及通气功能受阻的总比例为4.65%,显著低于纯钛接骨板组和镍钛合金组,差异有统计学意义(χ^(2)=6.824,P<0.05),MIPO接骨板组术后发生胸腔内感染、肺部感染、肺不张、气胸及术后出血的总比例为4.65%,显著低于纯钛接骨板组和镍钛合金组,差异有统计学意义(χ^(2)=7.453,P<0.05)。结论 针对多发肋骨骨折者,胸腔镜下行MIPO接骨板内固定,术后恢复快,显著降低疼痛水平和机体炎症因子水平,且并发症少,能促进术后早期恢复。Objective To investigate the clinical effect of three different types of rib plate in the treatment of rib frac⁃ture under thoracoscopy.Methods A total of 121 patients with multiple rib fractures who received internal fixation treatment in Fuzhou Second Hospital from June 2021 to June 2022 were selected as subjects.In this study,partici⁃pants were all treated with thoracoscopic internal fixation of rib fracture under general anesthesia and double-lumen tracheal intubation,and were divided into 3 groups according to the internal fixation materials used(17 cases in Niti⁃nol group,61 cases in pure titanium plate group and 43 cases in MIPO plate group).The operation and postoperative recovery of each group,the changes of pain score and C-reactive protein level before and after treatment,the abnor⁃mal arterial blood gas and lung function of each group during the intervention,and the postoperative complications of each group were analyzed.Results The intraoperative blood loss in MIPO bone plate group was(56.8±9.6)mL,and the total postoperative thoracic drainage was(45.2±12.7)mL less than that in pure titanium bone plate group and Nitinol group,and the difference was statistically significant(F=35.010,26.367,P<0.05).The drainage tube removal time and hospitalization time of MIPO bone plate group were(2.1±0.5)d and(6.2±2.1)d,respectively,which were shorter than those of pure titanium bone plate group and Nitinol group,and the difference was statistically significant(F=7.117,10.748,P<0.05).Postoperative pain scores and C-reactive protein levels in MIPO bone plate group were(2.1±0.3)points and(7.2±1.2)mg/L,respectively,lower than those in pure titanium bone plate group and Nitinol group,and the difference was statistically significant(F=7.538,12.451,P<0.05).The total proportion of hypoxemia,hyperventilation,carbon dioxide storage and obstruction of ventilation function in MIPO bone plate group was 4.65%,significantly lower than that in pure titanium bone plate group and Nitinol group,and the difference was st

关 键 词：肋骨骨折 胸腔镜治疗 微创接骨板 镍钛合金 纯钛接骨板 

分 类 号：R687[医药卫生—骨科学]