管形钢板与纯钛爪形环抱器治疗多发肋骨骨折的疗效比较  

Therapeutic effects of internal fixation for multiple rib fractures:choosing the embracing fixator or tubular plate?

作　　者：张荣灿 何武兵[1] 陈品华 王若礼 何雪义 Zhang Rongcan;He Wubing;Chen Pinhua;Wang Ruoli;He Xueyi(Provincial Clinical Medical College of Fujian Medical University,Department of Emergency Trauma Surgery,Fujian Provincial Hospital,Fujian Trauma Medicine Center,Fujian Key Laboratory of Emergency Medicine,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院急诊创伤外科,福建省创伤医学中心,福建省急诊医学重点实验室,福州350001

出　　处：《创伤外科杂志》2023年第9期676-680,共5页Journal of Traumatic Surgery

基　　金：福建省自然科学基金(2020J011076);福建省医学创新课题(2020CXA007);福建省卫生健康软科学研究课题(2020RK003)。

摘　　要：目的比较1/3管形钢板与纯钛爪形环抱器在多发肋骨骨折切开复位内固定治疗中的临床疗效。方法回顾性分析福建省立医院2015年1月1日—2021年5月31日收治的行切开复位内固定的72例多发肋骨折患者的临床资料,按术中使用内固定材料类型分为1/3管形钢板组(钢板组)和纯钛爪形环抱器组(环抱器组)。其中钢板组35例,男性22例,女性13例;年龄32~72岁,平均51.6岁;环抱器组37例,男性29,女性8例;年龄34~79岁,平均52.2岁。致伤原因:道路交通伤36例,高处坠落伤18例,钝器伤18例。比较两组手术时间、术中出血量、胸腔闭式引流率、引流管置管天数、住院时间、术前和术后视觉模拟评分(visual analogue scale,VAS)、住院费用、住院费用影响因素和术后并发症等。结果钢板组手术时间(112.43±31.09)min长于环抱器组(91.49±29.69)min,术中出血量(86.60±54.10)mL多于环抱器组(61.40±39.80)mL,术后留置胸腔闭式引流率61.50%高于环抱器组38.50%,平均置管天数(5.0±2.5)d长于环抱器组(4.2±2.4)d,住院天数(20.5±10.3)d多于环抱器组(12.1±4.1)d,住院费用(5.76±2.39)万元高于环抱器组(2.74±1.04)万元,差异均有统计学意义(P<0.05)。两组术前及术后VAS比较差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示住院费用主要与采用的手术方式和术中出血量有关。钢板组术后慢性疼痛发生率较环抱器组低(P<0.05),而两组术后肺不张、肺部感染和切口感染率比较差异无统计学意义(P>0.05)。结论应用纯钛爪形环抱器治疗多发肋骨骨折相对1/3管形钢板手术时间较短,术中出血量少,住院时间短,住院费用少但术后慢性疼痛率高,具有更多的优势,值得临床推广。Objective To investigate the clinical effect of using 1/3 tubular plates vs.pure titanium claw embracing fixator in the treatment of multiple rib fractures by open reduction and internal fixation.Methods A retrospective analysis was conducted on clinical data of 72 patients with multiple rib fractures who underwent open reduction and internal fixation at Fujian Provincial Hospital from Jan.1,2015 to May 31,2021.According to the material of the internal fixator,patients were divided into tubular plate group(1/3 tubular steel plate used)and embracing fixator group(a pure titanium claw-shaped embracing fixator used).There were 35 cases in the tubular plate group:22 male and 13 female aged 32-72 years,mean 51.6 years;and 37 cases in the embracing fixator group:29 male and 8 female aged 34-79 years,mean 52.2 years.Causes of the rib fractures included 36 road traffic accidents,18 falls from height and 18 of blunt type.The operation time,intraoperative blood loss,need for closed thoracic drainage,days the drainage tube retained,length of hospital stay,preoperative and postoperative visual analog scale(VAS)for pain assessment,hospitalization costs and the influencing factors,as well as postoperative complications were recorded and compared between two groups.Results Compared with embracing fixator group,the tubular plate group revealed a significantly longer operation time(min,112.43±31.09 vs.91.49±29.69),more intraoperative blood loss(mL,86.60±54.10 vs.61.40±39.80),higher rate for postoperative closed thoracic drainage(61.50%vs.38.50%),more days for retained drainage tube(d,5.0±2.5 vs.4.2±2.4),longer length of hospital stay(d,20.5±10.3 vs.12.1±4.1)and more hospitalization cost(10 thousand CNY,5.76±2.39 vs.2.74±1.04,all P<0.05).Preoperative and postoperative VAS showed no significant difference(P>0.05).Multivariate logistic regression analysis of the major factors affecting hospitalization costs showed that it was primarily related to the surgery procedures and intraoperative blood loss.The incidence of postope

关 键 词：多发肋骨骨折 环抱器 钢板 内固定 

分 类 号：R683.1[医药卫生—骨科学]