全胸腔镜下腔镜接骨板内固定与剖胸接骨板内固定治疗多发肋骨骨折的疗效比较  

Comparative efficacy of internal fixation with video thoracoscopy-assisted rib plating and open thoracotomy in the treatment of multiple rib fracture

作　　者：毕磊 晨正宇 邓意平 艾成 杨富瑜 吕忠柱 Bi Lei;Chen Zhengyu;Deng Yiping;Ai Cheng;Yang Fuyu;Lyu Zhongzhu(Department of Cardiothoracic Surgery,Affiliated Bishan Hospital of Chongqing Medical University,Chongqing 402760,China)

机构地区：[1]重庆医科大学附属璧山医院胸心外科,重庆402760

出　　处：《中华创伤杂志》2025年第3期289-296,共8页Chinese Journal of Trauma

基　　金：重庆市璧山区社会民生领域科技计划项目(BSKJ20210035)。

摘　　要：目的比较全胸腔镜下腔镜接骨板内固定与剖胸接骨板内固定治疗多发肋骨骨折的疗效。方法采用回顾性队列研究分析2021年5月至2023年5月重庆医科大学附属璧山医院收治的65例多发肋骨骨折患者的临床资料,其中男42例,女23例;年龄19~75岁[(51.6±7.0)岁]。33例行全胸腔镜下腔镜接骨板内固定(胸腔镜组),32例行剖胸接骨板内固定治疗(剖胸组)。比较2组手术切口长度、术中出血量、手术时长、术后胸腔闭式引流管带管时长、术后胸腔引流量、住院时长;术后6、12、24、48、72 h视觉模拟评分(VAS);术前,术后7 d、6个月及末次随访时用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及最大呼气峰流速(PEF);术后6个月及末次随访时骨折愈合优良率;术后并发症发生率。结果患者均获随访12~24个月[(15.2±2.2)个月]。胸腔镜组手术切口长度为(4.3±1.5)cm,术中出血量为(65.2±15.0)ml,手术时长为(68.8±13.1)min,均短于或少于剖胸组的(7.2±1.7)cm、(93.3±16.3)ml、(93.7±15.9)min(P<0.01)。胸腔镜组术后带管时长为(3.8±1.5)d,术后胸腔引流量为(357.3±38.6)ml,住院时长为(12.3±1.7)d,均少于或短于剖胸组的(5.9±1.8)d、(424.9±45.4)ml、(18.6±2.5)d(P<0.01)。术后6、12、24、48 h,胸腔镜组VAS分别为(5.1±1.6)分、(4.7±1.5)分、(4.2±1.5)分、(3.9±1.3)分,均低于剖胸组的(8.4±1.8)分、(7.3±1.5)分、(6.3±1.3)分、(5.2±1.2)分(P<0.01);2组术后72 h VAS差异无统计学意义(P>0.05)。术前、术后6个月及末次随访时,2组FVC、FEV1和PEF差异均无统计学意义(P>0.05);术后7 d,胸腔镜组FVC为(4.17±0.25)L,FEV1为(2.24±0.24)L,PEF为(5.53±0.50)L/s,均高于剖胸组的(4.01±0.23)L、(2.12±0.21)L、(5.23±0.42)L/s(P<0.05)。术后6个月,胸腔镜组骨折愈合优良率为94%(31/33),剖胸组骨折愈合优良率为97%(31/32)(P>0.05);末次随访时,2组骨折愈合优良率均为100%(P>0.05)。胸腔镜组并发症发生率为15%(5/33),低于剖胸组的Objective To compare the efficacy of internal fixation with video thoracoscopy⁃assisted rib plating and open thoracotomy in the treatment of multiple rib fracture.Methods A retrospective cohort study was conducted to analyze the clinical data of 65 patients with multiple rib fracture who were admitted to Affiliated Bishan Hospital of Chongqing Medical University between May 2021 and May 2023,including 42 males and 23 females,aged 19⁃75 years[(51.6±7.0)years].Of all,33 patients were treated with internal fixation with video thoracoscopy⁃assisted rib plating(thoracoscopy group),while other 32 patients treated with internal fixation with open thoracotomy(thoracotomy group).Two groups were compared in terms of surgical incision length,intraoperative blood loss,surgical duration,duration of postoperative drainage tube placement,postoperative chest tube drainage,and length of hospital stay.Postoperative pain was assessed using the visual analogue scale(VAS)at 6,12,24,48,and 72 hours postoperatively.Forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),and peak expiratory flow(PEF)were detected preoperatively,at 7 days,6 months postoperatively and at the last follow⁃up.The excellent and good rate of fracture healing was evaluated at 6 months postoperatively and at the last follow⁃up.The incidence of postoperative complications was also assessed.Results All the patients were followed up for 12⁃24 months[(15.2±2.2)months].The surgical incision length,intraoperative blood loss,and surgical duration were(4.3±1.5)cm,(65.2±15.0)ml,and(68.8±13.1)minutes in the thoracoscopy group,shorter or less than(7.2±1.7)cm,(93.3±16.3)ml,and(93.7±15.9)minutes in the thoracotomy group(P<0.01).The duration of drainage tube placement,postoperative chest tube drainage volume and length of hospital stay were(3.8±1.5)days,(357.3±38.6)ml and(12.3±1.7)days in the thoracoscopy group,shorter or less than(5.9±1.8)days,(424.9±45.4)ml,and(18.6±2.5)days in the thoracotomy group(P<0.01).At 6,12,24,and 48 h

关 键 词：胸部损伤 肋骨骨折 胸腔镜检查 骨折固定术 内 

分 类 号：R683.1[医药卫生—骨科学] R687.32[医药卫生—外科学] R826.25[医药卫生—临床医学]