胸腔镜下切开复位内固定术治疗多发肋骨骨折合并血气胸的效果观察  

Observation of efficacy of thoracoscopic open reduction and internal fixation in the treatment of multiple rib fractures with hemopneumothorax

作　　者：秦伟[1] 林涛 王永革[2] Qin Wei;Lin Tao;Wang Yongge(Department of Trauma Center,Anyang People’s Hospital,Anyang 455000,China;Department of Emergency,Anyang People’s Hospital,Anyang 455000,China)

机构地区：[1]安阳市人民医院创伤中心,安阳455000 [2]安阳市人民医院急诊科,安阳455000

出　　处：《中国实用医刊》2023年第5期42-45,共4页Chinese Journal of Practical Medicine

摘　　要：目的探究胸腔镜下切开复位内固定术治疗多发肋骨骨折合并血气胸的临床疗效。方法抽取2019年12月至2021年12月于安阳市人民医院就诊的多发骨折合并血气胸患者92例,回顾性分析患者的临床资料。43例患者采用保守治疗(保守组),49例患者采用胸腔镜下切开复位内固定术进行治疗(固定组)。比较两组临床指标(镇痛持续时间、胸管引流时间、住院时间、骨折愈合时间);比较两组患者入院时及伤后第3、7天疼痛情况[视觉模拟评分法(VAS)评分];比较两组入院时及出院前凝血功能[凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)];比较两组伤后第30天骨愈合情况。统计两组治疗期间不良反应发生情况。结果固定组各项临床指标时间均短于保守组(P均<0.05)。伤后第3天,两组VAS评分均较入院时下降,且固定组低于保守组(P<0.05);伤后第7天,两组VAS评分均较入院时下降,且固定组低于保守组(P<0.05)。出院前,两组TT、APTT、PT水平均高于入院时(P均<0.05),但固定组与保守组比较差异未见统计学意义(P>0.05)。伤后第30天,固定组骨愈合各项指标均高于保守组(P均<0.05)。治疗期间,固定组不良事件总发生率(6.1%,3/49)低于保守组(20.9%,9/43),P<0.05。结论胸腔镜下切开复位内固定术可有效提高多发肋骨骨折合并血气胸患者恢复速度,促进患者骨愈合,减轻疼痛感,且具有较好的安全性。Objective To investigate the clinical efficacy of thoracoscopic open reduction and internal fixation in the treatment of multiple rib fractures with hemopneumothorax.Methods A total of 92 patients with multiple fractures complicated by hemopneumothorax treated in Anyang People’s Hospital from December 2019 to December 2021 were selected.And their clinical data were retrospectively analyzed.Among the patients,43 cases were given conservative treatment(conservative group),and 49 cases were treated by thoracoscopic open reduction combined with internal fixation(fixation group),The clinical indicators(duration of analgesia,chest tube drainage time,hospital stay,fracture healing time)were compared between the two groups.The pain status assessed by visual analogue scale(VAS)at admission and on the 3rd day and 7th days after injury were compared between the two groups.The coagulation function assessed by thrombin time(TT),activated partial thromboplastin time(APTT),and prothrombin time(PT)at admission and before discharge of the two groups were compared.The bone healing status of the two groups were compared on the 30th day after injury.And the occurrence of adverse events during treatment of the two groups were counted.Results The time of clinical parameters in the fixation group were significantly shorter than those in the conservative group(all P<0.05).On the 3rd day after injury,the VAS score of the two groups were significantly reduced,compared with those at admission;and the score in the fixation group was significantly lower than that in the conservative group(P<0.05).On the 7th day after injury,the VAS score of the two groups were significantly lower than those at admission,and the score in the fixation group was significantly lower than that in the conservative group(P<0.05).Before discharge,the TT,APTT and PT in the two groups were significantly higher,compared with those at admission(allP<0.05),however,there was no significant difference in the above indexes between the fixation group and the conservative g

关 键 词：肋骨骨折 切开复位内固定术 血气胸 保守治疗 骨愈合 

分 类 号：R687.3[医药卫生—骨科学] R655[医药卫生—外科学]