胸腔镜复位内固定对老年肋骨骨折患者术后康复的影响  

The effect of thoracoscopic reduction and internal fixation on postoperative rehabilitation of elderly patients with rib fractures

作　　者：王永胜 郭红[2] 赵元生 WANG Yongsheng;GUO Hong;ZHAO Yuansheng(Department of Cardiothoracic Surgery,Sinopharm Tongmei General Hospital,Datong 037003,China;Department of Health Management,Air Force Hospital,Central Theater Command)

机构地区：[1]国药同煤总医院心胸外科,山西大同037003 [2]中国人民解放军中部战区空军医院健康管理科

出　　处：《腹腔镜外科杂志》2024年第12期909-914,共6页Journal of Laparoscopic Surgery

基　　金：山西省科学技术研究与开发项目(202004D289106)。

摘　　要：目的:探讨胸腔镜复位内固定在老年肋骨骨折患者中的应用效果及对术后康复的影响。方法:选取2020年5月至2023年6月收治的148例老年肋骨骨折患者,根据手术方案分为两组,对照组(n=73)在CT平扫引导下完成常规切开复位内固定术,观察组(n=75)在CT三维重建引导下完成胸腔镜复位内固定术。观察两组手术相关指标、并发症、手术前后炎症指标(C反应蛋白、白介素-6、白介素-8)及肺功能(每分钟最大通气量、用力肺活量、第1秒用力呼气容积)、术区局部血运变化情况。结果:观察组手术时间、下床活动时间、镇痛药应用时间、住院时间、骨折愈合时间均短于对照组,术中出血量少于对照组(P<0.05);术后第7天、1个月、3个月,观察组血清白介素-6、C反应蛋白、白介素-8水平低于对照组(P<0.05);术后1个月、3个月,两组第1秒用力呼气容积、用力肺活量、每分钟最大通气量差异无统计学意义(P>0.05),观察组术后骨折处皮肤血运情况优于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。结论:胸腔镜复位内固定术治疗老年肋骨骨折定位精准,创伤小,可加速术后康复进程,降低术后炎症反应,减轻对骨折断端血运的影响,促进骨折早期愈合,是安全、有效、可靠的,符合快速康复外科的要求。Objective:To investigate the application effect of thoracoscopic reduction and internal fixation in elderly patients with rib fractures and its impact on postoperative rehabilitation.Methods:A total of 148 elderly patients of rib fracture from May 2020 to Jun.2023 were selected and divided into two groups according to different surgical methods,73 cases in the control group were treated with conventional incision reduction and internal fixation under CT plain scanning guidance,and 75 cases in the observation group were treated with thoracoscopic reduction and internal fixation under CT three-dimensional reconstruction guidance.Surgery-related indexes,complications,pre-and post-surgery inflammatory markers(C-reactive protein,interleukin-6,interleukin-8)and pulmonary function(maximum ventilation per minute,forced vital capacity,forced expiratory volume in one second),and changes in local blood flow in the operation area were observed.Results:The observation group had shorter operation time,ambulation time,analgesic application time,hospitalization time and fracture healing time than the control group(P<0.05).The intraoperative blood loss was less in the observation group(P<0.05).The levels of serum interleukin-6,C-reactive protein,and interleukin-8 in the observation group were lower than those in the control group at 7 d,1 month,and 3 months after surgery(P<0.05).There was no significant difference in forced expiratory v olume in one second,forced vital capacity and maximum ventilation per minute between the two groups in 1 month and 3 months after surgery(P>0.05).One month and three months after surgery,the skin blood circulation of fracture site in observation group was better than that in control group(P<0.05).The incidence of complications in the observation group was 5.33%,which was lower than that in the control group(16.44%,P<0.05).Conclusions:Thoracoscopic reduction and internal fixation for the treatment of elderly rib fractures has precise surgical positioning,minimal trauma,can accelerate postoperative

关 键 词：肋骨骨折 胸腔镜检查 康复 老年人 

分 类 号：R683.1[医药卫生—骨科学]