中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
4期
410-413
,共4页
施舜缤%俞力超%朱孝中%沈振亚%郁珲
施舜繽%俞力超%硃孝中%瀋振亞%鬱琿
시순빈%유력초%주효중%침진아%욱혼
连枷胸%内固定%呼吸功能%肋骨骨折
連枷胸%內固定%呼吸功能%肋骨骨摺
련가흉%내고정%호흡공능%륵골골절
Flail chest%Internal fixation%Pulmonary function%Rib fracture
目的 比较肋骨内固定术和外固定胸廓治疗创伤性连枷胸的临床疗效.方法 回顾性分析2006年1月至2009年6月收治的86例以创伤性连枷胸为主的多发伤病例的临床资料,分为内固定组和外固定组.内固定组45例,采用镍钛记忆合金环抱式接骨器内固定肋骨骨折;外固定组41例,采用外固定胸廓非手术保守治疗.比较2组的临床疗效.结果 内固定组患者胸壁畸形均消失,而外固定组中有19例患者遗留胸壁畸形.内固定组患者平均住院时间、平均住ICU时间和平均机械通气时间均短于外固定组[(15.1±1.8)d与(22.9±2.8)d,t=-15.724;(5.7±1.5)d与(14.4±2.9)d,t=-17.711;(3.9±1.5)d与(11.6 ±2.3)d,t=-17.256;P均＜0.01],内固定组患者呼吸系统并发症[包括肺部炎症或(和)肺不张或(和)呼吸功能衰竭]的发生率低于外固定组(35.6%与70.7%,x2=10.641,P＜0.01).出院3个月后,内固定组患者肺功能指标包括肺总量、用力肺活量、1秒钟用力呼气容积、呼气峰流量、75%肺活量最大呼气流量均高于外固定组[(89.5±3.1)%与(79.1±5.1)%,t=11.705;(80.2±2.8)%与(69.8±3.8)%,t=14.241;(74.8±4.4)%与(71.9±3.6)%,t=3.201;(82.8±4.4)%与(79.8±4.9)%,t=2.885;(68.2±2.2)%与(61.9±2.9)%,t=11.286;P均＜0.01].结论 肋骨内固定手术治疗创伤性连枷胸,可以迅速纠正畸形,稳定胸廓,消除反常呼吸,治疗过程顺利,缩短重症监护及住院时间,减少并发症,还可以减轻连枷胸对患者远期肺功能的影响.采用镍钛记忆合金环抱式接骨器内固定肋骨,手术简单、方便,疗效确切.
目的 比較肋骨內固定術和外固定胸廓治療創傷性連枷胸的臨床療效.方法 迴顧性分析2006年1月至2009年6月收治的86例以創傷性連枷胸為主的多髮傷病例的臨床資料,分為內固定組和外固定組.內固定組45例,採用鎳鈦記憶閤金環抱式接骨器內固定肋骨骨摺;外固定組41例,採用外固定胸廓非手術保守治療.比較2組的臨床療效.結果 內固定組患者胸壁畸形均消失,而外固定組中有19例患者遺留胸壁畸形.內固定組患者平均住院時間、平均住ICU時間和平均機械通氣時間均短于外固定組[(15.1±1.8)d與(22.9±2.8)d,t=-15.724;(5.7±1.5)d與(14.4±2.9)d,t=-17.711;(3.9±1.5)d與(11.6 ±2.3)d,t=-17.256;P均＜0.01],內固定組患者呼吸繫統併髮癥[包括肺部炎癥或(和)肺不張或(和)呼吸功能衰竭]的髮生率低于外固定組(35.6%與70.7%,x2=10.641,P＜0.01).齣院3箇月後,內固定組患者肺功能指標包括肺總量、用力肺活量、1秒鐘用力呼氣容積、呼氣峰流量、75%肺活量最大呼氣流量均高于外固定組[(89.5±3.1)%與(79.1±5.1)%,t=11.705;(80.2±2.8)%與(69.8±3.8)%,t=14.241;(74.8±4.4)%與(71.9±3.6)%,t=3.201;(82.8±4.4)%與(79.8±4.9)%,t=2.885;(68.2±2.2)%與(61.9±2.9)%,t=11.286;P均＜0.01].結論 肋骨內固定手術治療創傷性連枷胸,可以迅速糾正畸形,穩定胸廓,消除反常呼吸,治療過程順利,縮短重癥鑑護及住院時間,減少併髮癥,還可以減輕連枷胸對患者遠期肺功能的影響.採用鎳鈦記憶閤金環抱式接骨器內固定肋骨,手術簡單、方便,療效確切.
목적 비교륵골내고정술화외고정흉곽치료창상성련가흉적림상료효.방법 회고성분석2006년1월지2009년6월수치적86례이창상성련가흉위주적다발상병례적림상자료,분위내고정조화외고정조.내고정조45례,채용얼태기억합금배포식접골기내고정륵골골절;외고정조41례,채용외고정흉곽비수술보수치료.비교2조적림상료효.결과 내고정조환자흉벽기형균소실,이외고정조중유19례환자유류흉벽기형.내고정조환자평균주원시간、평균주ICU시간화평균궤계통기시간균단우외고정조[(15.1±1.8)d여(22.9±2.8)d,t=-15.724;(5.7±1.5)d여(14.4±2.9)d,t=-17.711;(3.9±1.5)d여(11.6 ±2.3)d,t=-17.256;P균＜0.01],내고정조환자호흡계통병발증[포괄폐부염증혹(화)폐불장혹(화)호흡공능쇠갈]적발생솔저우외고정조(35.6%여70.7%,x2=10.641,P＜0.01).출원3개월후,내고정조환자폐공능지표포괄폐총량、용력폐활량、1초종용력호기용적、호기봉류량、75%폐활량최대호기류량균고우외고정조[(89.5±3.1)%여(79.1±5.1)%,t=11.705;(80.2±2.8)%여(69.8±3.8)%,t=14.241;(74.8±4.4)%여(71.9±3.6)%,t=3.201;(82.8±4.4)%여(79.8±4.9)%,t=2.885;(68.2±2.2)%여(61.9±2.9)%,t=11.286;P균＜0.01].결론 륵골내고정수술치료창상성련가흉,가이신속규정기형,은정흉곽,소제반상호흡,치료과정순리,축단중증감호급주원시간,감소병발증,환가이감경련가흉대환자원기폐공능적영향.채용얼태기억합금배포식접골기내고정륵골,수술간단、방편,료효학절.
Objective To compare the effects of rib internal fixation and thoracic external fixation in treatment of traumatic flail chest. Methods Eighty six cases of traumatic flail chest with multiple injuries,admitted to hospital from January 2006 to June 2009 ,were recruited into the study and divided into rib internal fixation and thoracic external fixation groups randomly. The clinical data were analyzed retrospectively. Rib internal fixations with Ti-Ni shape memory alloy embracing connector were performed in internal-fixation group(n = 45) and thoracic external fixations were performed in external-fixation group(n = 41). The outcomes were compared between the two groups. Results No patient in internal-fixation group developed chest wall deformity,while 19 patients in external-fixation group had chest wall deformity left. The mean times of hospital stay([ 15. 1 ± 1.8]d vs [22. 9 ±2. 8]d,t = - 15. 724,P ＜0. 01) ,ICU stay([5.7 ± 1.5]d vs [ 14. 4 ±2. 9]d,t =- 17.711, P ＜ 0. 01), and mechanical ventilation([ 3.9 ± 1.5 ] d vs [ 1 1.6 ± 2. 3 ] d, t = - 17. 256, P ＜ 0. 01),in internal-fixation group were significantly shorter than those in external-fixation group. The occurrence rate of respiratory complications (including pulmonary inflammation and (or) atelectasis and (or) respiratory failure)in internal-fixation group was significantly lower than those in external-fixation group(35.6% vs. 70. 7% ,x2 =10.641,P ＜ 0.01). Followed-up data of three months after discharge showed that the pulmonary function parameters, such as total lung capacity([ 89. 5 ± 3. 1 ] % vs. [ 79. 1 ± 5. 1 ] %, t = 11. 705, P ＜ 0. 01), forced vital capacity([ 80. 2 ± 2. 8 ] % vs. [ 69. 8 ± 3. 8 ] % ,t = 14. 241 ,P ＜0. 01) ,forced expiratory volume in the 1st second ([74.8 ±4.4]% vs. [71.9 ±3.6]% ,t =3.201,P ＜0.01),peak expiratory flow ([82.8 ±4.4]%vs. [79. 8 ±4. 9]% ,t =2. 885,P ＜0. 01) and forced expiratory flows at 75% of the vital capacity( [68.2 ±2. 2] % vs. [61.9 ± 2. 9 ]%, t = 11. 286; P ＜ 0. 01) were significantly higher in internal-fixation group than those in external-fixation group. Conclusion Rib internal fixation for traumatic flail chest can quickly correct chest wall deformity, stabilize thoracis and eliminate paradoxical chest wall movement. Patients accepted this treatment have a shorter therapy process during the intensive care unit and hospital stay, less pulmonary complications. They also show less long-term restrictive pulmonary functions impairment, when compared to the patients in the thoracic external fixation group. Rib internal fixation with Ti-Ni shape memory alloy embracing connector is a simple and effective therapy.
