CAJ | 학술논문

目的比较胸腔镜手术内固定与传统剖胸内固定治疗创伤性多发肋骨骨折的效果.方法回顾性分析2005年7月-2012年9月收治的56例创伤性多发肋骨骨折内固定手术患者的临床资料.根据治疗方法分为胸腔镜手术内固定组(胸腔镜组,27例)和传统剖胸内固定组(剖胸组,29例).比较两组手术时间、术中出血量、呼吸机通气支持率、机械通气时间、ICU住院时间、肺感染发生率、伤后3d视觉模拟评分(visual analogue scale,VAS)、死亡率等. 结果与剖胸组比较,胸腔镜组手术时间[(128.9 ±21.1) min∶(140.7±24.2) min[、呼吸机通气支持率(70％∶76％)及死亡率(4％∶7％)差异无统计学意义(P＞0.05),术中出血量[(321.1 ±30.1)ml∶ (438.1±43.2)ml]减少(P＜0.01),机械通气时间[(4.3±2.1)d∶(7.2±1.6)d]缩短(P＜0.01),ICU住院时间[(5.9±21.1)d∶(8.5±1.7)d]缩短(P＜0.01),肺感染发生率(33％∶90％)减低(P＜0.01),VAS[(7.0±1.4)分∶(8.3±0.9)分]下降(P＜0.01). 结论胸腔镜手术内固定治疗创伤性多发肋骨骨折具有术中出血少、术后机械通气及ICU住院时间短、肺感染率低等优点,疗效优于传统剖胸内固定.
목적 비교흉강경수술내고정여전통부흉내고정치료창상성다발륵골골절적효과.방법 회고성분석2005년7월-2012년9월수치적56례창상성다발륵골골절내고정수술환자적림상자료.근거치료방법분위흉강경수술내고정조(흉강경조,27례)화전통부흉내고정조(부흉조,29례).비교량조수술시간、술중출혈량、호흡궤통기지지솔、궤계통기시간、ICU주원시간、폐감염발생솔、상후3d시각모의평분(visual analogue scale,VAS)、사망솔등. 결과 여부흉조비교,흉강경조수술시간[(128.9 ±21.1) min∶(140.7±24.2) min[、호흡궤통기지지솔(70％∶76％)급사망솔(4％∶7％)차이무통계학의의(P＞0.05),술중출혈량[(321.1 ±30.1)ml∶ (438.1±43.2)ml]감소(P＜0.01),궤계통기시간[(4.3±2.1)d∶(7.2±1.6)d]축단(P＜0.01),ICU주원시간[(5.9±21.1)d∶(8.5±1.7)d]축단(P＜0.01),폐감염발생솔(33％∶90％)감저(P＜0.01),VAS[(7.0±1.4)분∶(8.3±0.9)분]하강(P＜0.01). 결론 흉강경수술내고정치료창상성다발륵골골절구유술중출혈소、술후궤계통기급ICU주원시간단、폐감염솔저등우점,료효우우전통부흉내고정.
Objective To compare the therapeutic effect of video-assisted thoracoscopic surgery and traditional thoracotomy in fixation of traumatic multiple rib fractures.Methods Clinical data of 56 patients with traumatic multiple rib fractures treated surgically between July 2005 and September 2012 were analyzed retrospectively.Based on the treatments,the patients were assigned to video-assisted thoracoscopy group (thoracoscopy group,n =27) and traditional thoracotomy group (thoracotomy group,n =29).A comparison was done on the variables including operation time,intraoperative blood loss,ventilator support rate,duration of mechanical ventilation,length of ICU stay,incidence of lung infections,visual analogue scale (VAS) at day 3 postinjury and mortality between the two groups.Results Operation time [(128.9 ± 21.1) min vs (140.7 ± 24.2) min],ventilator support rate (70％ vs 76％) and mortality (4％ vs 7％) in thoracoscopy group revealed no statistical differences compared with thoracotomy group (P ＞ 0.05),but intraoperative blood loss [(321.1 ± 30.1)ml vs (438.1 ± 43.2)ml],duration of mechanical ventilation [(4.3 ± 2.1) d vs (7.2 ± 1.6) d],length of ICU stay [(5.9 ± 21.1) d vs (8.5 ± 1.7) d],incidence of lung infection (33％ vs 90％),and VAS [(7.0 ± 1.4) points vs (8.3 ± 0.9) points] were significantly reduced in thoracoscopy group than in thoracotomy group (all P ＜ 0.01).Conclusion Video-assisted thoracoscopic surgery is characterized by fewer intraoperative bleeding,shorter duration of mechanical ventilation and ICU stay,and lower lung infection rate during treatment of traumatic multiple rib fractures compared to traditional thoracotomy.