开胸与胸腔镜下记忆合金环抱器内固定治疗肋骨骨折的疗效比较  

Thoracoscopic versus thoracotomic internal fixation by memory alloy embracing fixator for rib fractures

作　　者：张书豪 沈庆伟 袁勇[1] 任弘旭 李超 邓旭阳 李箫曲 Zhang Shuhao;Shen Qingwei;Yuan Yong;Ren Hongxu;Li Chao;Deng Xuyang;Li Xiaoqu(Department of Thoracic Surgery,West China Hospital of Sichuan University,Chengdu610041,China;Department of Thoracic Surgery,Sichuan GEM Flower Hospital,Chengdu610213,China)

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]四川宝石花医院胸外科,成都610213

出　　处：《创伤外科杂志》2024年第7期523-527,共5页Journal of Traumatic Surgery

基　　金：成都市医学科研课题(2021383)。

摘　　要：目的 研究胸腔镜下记忆合金环抱器(MAEF)内固定治疗肋骨骨折(RF)的临床效果。方法 回顾性分析2016年1月—2023年6月于四川宝石花医院胸外科治疗的78例RF患者的临床资料,男性47例,女性31例;年龄30~65岁,平均50.5岁;致伤原因:道路交通伤50例,高处坠落伤22例,其他6例。依据手术方法分为胸腔镜组(43例)和开胸组(35例)。开胸组行开胸MAEF内固定,胸腔镜组行胸腔镜下MAEF内固定。观察并比较两组患者术中出血量、手术时间、术后引流时间、呼吸机支持时间及术后住院时间等围术期指标;术前及术后7 d疼痛程度;用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及最大呼气峰流速(PEF)等肺功能指标;术后6个月骨折愈合情况;术后并发症。结果 胸腔镜组术中出血量、手术时间、术后引流时间、呼吸机支持时间及术后住院时间均少于开胸组[(182.1±26.4)mL vs.(218.1±18.0)mL,(54.7±5.8)min vs.(82.3±7.5)min,(2.33±0.41)d vs.(4.29±0.40)d,(1.66±0.24)d vs.(3.35±0.36)d,(7.55±0.71)d vs.(13.50±0.79)d],差异有统计学意义(P<0.05)。术后7 d,胸腔镜组VAS低于开胸组[(3.15±0.20)分vs.(3.30±0.23)分],FVC、FEV1、PEF均大于开胸组[(4.26±0.26)L vs.(4.07±0.24)L,(2.22±0.23)L vs.(2.11±0.20)L,(5.72±0.51)L/s vs.(5.38±0.46)L/s],差异有统计学意义(P<0.05)。术后6个月,两组骨折愈合优良率差异无统计学意义(93.0%vs.94.3%,P>0.05)。胸腔镜组肺部感染、肺不张、肋间神经痛等术后并发症发生率低于开胸组(4.7%vs.22.9%,P<0.05)。结论 胸腔镜下MAEF内固定治疗RF创伤小,术后恢复快,术后并发症少,有助于患者康复,但对术后6个月骨折愈合情况无显著影响。Objective To investigate the clinical effect of internal fixation of rib fractures by using memory alloy embracing fixator(MAEF)under thoracoscopy.Methods Clinical data of 78 cases of rib fractures admitted to the Department of Thoracic Surgery,Sichuan GEM Flower Hospital,from Jan.2016 to Jun.2023 were retrospec-tively analyzed,including 47 males and 31 females aged 30-65 years,mean 50.5 years.The injury mechanisms were road traffic injuries in 50 cases,falls from height in 22,and others in 6.According to the surgical method,patients were divided into thoracoscopy group(thoracoscopic MAEF internal fixation,n=43)and thoracotomy group(thora-cotomic MAEF internal fixation,n=35).The following variables were recorded and compared:perioperative indexes such as intraoperative blood loss,operation time,postoperative drainage time,ventilator support time and postopera-tive hospitalization time,pain degree before and 7 d after surgery,pulmonary function indicators such as forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),maximum peak expiratory flow rate(PEF),fracture healing at 6 months after surgery,and postoperative complications.Results Compared with the thoracotomy group,the thoracoscopy group showed much less intraoperative blood loss(mL,182.1±26.4 vs.218.1±18.0),op-eration time(min,54.7±5.8 vs.82.3±7.5),postoperative drainage time(d,2.33±0.41 vs.4.29±0.40),ventila-tor support time(d,1.66±0.24 vs.3.35±0.36)and postoperative hospitalization time(d,7.55±0.71 vs.13.50±0.79,all P<0.05).At 7 d after surgery,VAS was much lower in the thoracoscopy group than in the thoracotomy group(3.15±0.20 vs.3.30±0.23,P<0.05),and the pulmonary function indicators were much better:FVC(L,4.26±0.26 vs.4.07±0.24),FEV1(L,2.22±0.23 vs.2.11±0.20),PEF(L/s,5.72±0.51 vs.5.38±0.46,all P<0.05).At 6 months after surgery,the rate of excellent-to-good fracture healing revealed no significant difference between the two groups(93.0%vs.94.3%,P>0.05),but a much lower incidence of postoperative complications su

关 键 词：肋骨骨折 胸腔镜 记忆合金环抱器 内固定 肺功能 

分 类 号：R683.1[医药卫生—骨科学]