切开复位内固定治疗胸骨骨折合并肋软骨骨折的疗效  

Therapeutic effect of open reduction and internal fixation in the treatment of sternal fractures combined with costal cartilage fractures

作　　者：陈松林[1] 陈检明[1] 钟京[1] 余小平[1] 宋志明[1] 郭军华[1] 蔡伟斌 郑育镇 易云峰[1] Chen Songlin;Chen Jianming;Zhong Jing;Yu Xiaoping;Song Zhiming;Guo Junhua;Cai Weibin;Zheng Yuzhen;Yi Yunfeng(Eastern War Zone Cardiothoracic Surgery Medical Center,Department of Cardiothoracic Surgery,909th Hospital of PLA Joint Logistics Support Force(Southeast Hospital Affiliated to Xiamen University),Zhangzhou,Fujian 363000,China)

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

出　　处：《创伤外科杂志》2023年第9期669-675,共7页Journal of Traumatic Surgery

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：目的探讨切开复位内固定手术治疗胸骨骨折合并肋软骨骨折的疗效。方法回顾性分析2013年10月—2021年9月联勤保障部队第九〇九医院心胸外科收治的胸骨骨折合并肋软骨骨折患者78例,男性43例,女性35例;年龄18~60岁,平均42.0岁。胸骨角骨折14例,胸骨体骨折64例;单侧肋软骨骨折42例,双侧肋软骨骨折36例;患者均合并纵隔挫伤。受伤至手术时间0~2d,平均1.1d。根据胸部固定方式不同分为治疗组(46例)和对照组(32例),治疗组行骨折切开复位内钢板固定手术,对照组行胸部护板胸壁外固定术。比较术前5min和术后1~7d静息和咳嗽咳痰时疼痛数字评分量表(numerical rating scale,NRS)评分,相应时间点第一秒用力呼气容量(forced expiratory volume in the first second,FEV1)和FEV1占用力肺活量百分比(forced expiratory volume in the first second/forced vital capacity,FEV1%),疼痛持续时间,总住院时间,骨痂形成时间,术后肺部感染并发症发生率以及术前5min及术后1、3、6个月和末次随访健康状况调查简表(short-form 36 health survey scale,SF-36)评分。结果患者均获随访12个月,两组患者术前5min静息时NRS评分[(8.8±0.3)分vs.(8.7±0.4)分],咳嗽咳痰时NRS评分[(9.0±0.5)分vs.(9.1±0.4)分],差异无统计学意义(P>0.05)。术后1~7d静息和咳嗽咳痰时NRS评分比较差异有统计学意义(P<0.001)。两组患者术前5minFEV1[(1.8±0.2)L vs.(1.7±0.3)L],FEV1%[(56.3±7.7)%vs.(55.6±8.5)%]比较差异无统计学意义(P>0.05)。术后1~7d相应时间点FEV1、FEV1%比较差异有统计学意义(P<0.001)。治疗组较对照组疼痛持续时间短[(7.9±0.8)d vs.(16.9±0.5)d],总住院时间短[(7.5±1.8)d vs.(10.7±1.9)d],骨痂形成时间短[(2.5±0.4)周vs.(3.2±0.8)周],术后肺部感染发生率低(6.5%vs.21.8%),差异有统计学意义(P<0.001)。两组术前5min SF-36评分[(53.3±2.7)分vs.(54.6±3.5)分],差异无统计学意义(P>0.05)。与对照组比较,治疗组术后1个月[(73.Objective To investigate the effect of open reduction and internal fixation in managing sternal fractures combined with costal cartilage fractures.Methods A retrospective analysis was performed on the clinical data of 78 patients with refractory hypoxemia caused by sternal fractures combined with costal cartilage fractures,who were admitted to the 909th Hospital of PLA Joint Logistic Support from Oct.2013 to Sep.2021.There were 45 male and 33 female aged 18-60 years,mean 42.0 years,with 14 sternal angle fractures and 64 sternal body fractures;42 affecting the unilateral costal cartilage and 36 affecting bilateral.All the 78 patients had mediastinal contusion and flail chest.The time from injury to operation was 0-2 d,1.1 d on average.Based on the fixation options,patients were divided into observation group by open reduction and internal plate fixation(n=46)and control group by external fixation with a chest plate on the chest wall(n=32).The following parameters were analyzed:pain assessment at 5 min before surgery and 1-7 d after surgery using the numerical rating scale(NRS)at the state of rest and cough or expectoration,the forced expiratory volume in the first second(FEV1)and the percentage of FEV1 in forced vital capacity(FEV1%)at the above mentioned time-point,duration of pain,length of hospital stay,callus formation time,incidence of postoperative pulmonary infection,and short form 36 health survey scale(SF-36)at 5 min before surgery and 1,3,6 months after surgery and final follow-up.Results All the patients were followed up for 12 months.NRS scores showed no significant differences at 5 min before surgery between observation and control groups,either at rest(8.8±0.3 vs.8.7±0.4)or at cough or expectoration(9.0±0.5 vs.9.1±0.4,both P>0.05),but significant differences at 1-7 d after surgery(all P<0.001).The FEV1 and FEV1%showed similar result,i.e.no significant difference at 5 min before surgery[observation vs.control:(1.8±0.2)L vs.(1.7±0.3)L;56.3%±7.7%vs.55.6%±8.5%],but significant differences at 1-7

关 键 词：胸骨骨折 肋软骨骨折 内固定 生活质量 

分 类 号：R683.1[医药卫生—骨科学]